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| Local recurrence rate as quality indicator in surgery for pancreatic cancer? |
| Carlo Alberto Pacilio a , ∗, Alessandro Cucchetti a , b , Giorgio Ercolani a , b |
a General and Oncologic Surgery Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
b Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
∗ Corresponding author.
E-mail address: carloalberto.pacilio@auslromagna.it (C.A. Pacilio). |
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Abstract As we all know, even with the current advancements regarding novel chemotherapy regimens, patients affected by pancreatic cancer (PC) have an extremely dismal prognosis (5-year survival rate 12% for all stages in the National Cancer Institute SEER database). Among the patients undergoing surgical treatment, the prognosis is mostly affected by recurrence. PC after surgery has mainly four patterns of recurrence, isolated or variously associated with each other: local, lymph nodal, peritoneal or distant (liver, lung, other sites). While distant recurrence can be reasonable mainly attributed to biological aggressiveness of the disease, the same statement is more debatable for the other types of recurrence, involving a possible role for surgical practice (Fig. 1). Regarding peritoneal recurrence, the role of surgery can be partially ruled out by performing peritoneal cytology lavage before any manipulation, in order to highlight if any occult peritoneal dissemination was present at the moment of surgery. Lymph nodal recurrence should not be attributed to surgery if we perform standard lymphadenectomy recommended in 2014 by the International Study Group on Pancreatic Surgery [1] . We guess that local recurrence for any oncologic surgeon of any site of digestive tract (or even human body) is something troublesome to accept. In a systematic review published by Kalisvaart et al. in 2020 [2] , local recurrence after pancreaticoduodenectomy (PD) for PC is reported to be as high as 28% (range 1%−28%) when it was the only site of recurrence and raises to 52% (range 1%−52%) when associated with other sites of recurrence. Regarding PC of the bodytail, a secondary analysis of the ESPAC-4 trial reported a local only recurrence rate of 20%, raised to 25% when associated to distant recurrence [3].
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2024, Vol. 23 
