Patterns of Recurrence After Surgery for Pancreatic Cancer

An accurate understanding of pancreatic cancer recurrence after seemingly successful surgery is essential for the development of novel strategies that can improve outcomes for patients. Currently, disease recurrence occurs in up to 80–90% of patients after resection and is the main cause of disease-specific mortality. The main recurrence patterns following resection for pancreatic cancer include hepatic metastases, peritoneal carcinomatosis, locoregional recurrence and pulmonary metastases. More than 75% of recurrences occur at distant sites, demonstrating that most patients with pancreatic cancer should be presumed to have systemic spread at the time of resection. The specific recurrence locations have different predictive factors and demonstrate distinct survival outcomes. Hepatic recurrence, peritoneal carcinomatosis and multiple-site recurrence occur early and are associated with relatively limited overall survival. On the other hand, isolated local or pulmonary recurrence seem to be associated with relatively favorable survival. Future studies that take into account the diverse behaviours of disease recurrence could contribute to improved prognosis stratification, new targets of treatment, and a more patient-tailored approach for patients with pancreatic cancer.