Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma
Authors: Andel Paul C. M. , van Goor Iris W. J. M. , Augustinus Simone , Berrevoet Frederik , Besselink Marc G. , Bhojwani Rajesh , Boggi Ugo , Bouwense Stefan A. W. , Cirkel Geert A. , van Dam Jacob L. , Djanani Angela , Dorcaratto Dimitri , Dreyer Stephan , den Dulk Marcel , Frigerio Isabella , Ghorbani Poya , Goetz Mara R. , Groot Koerkamp Bas , Gryspeerdt Filip , Hidalgo Salinas Camila , Intven Martijn , Izbicki Jakob R. , Jorba Martin Rosa , Kauffmann Emanuele F. , Klug Reinhold , Liem Mike S. L. , Luyer Misha D. P. , Maglione Manuel , Martin-Perez Elena , Meerdink Mark , de Meijer Vincent E. , Nieuwenhuijs Vincent B. , Nikov Andrej , Nunes Vitor , Pando Elizabeth , Radenkovic Dejan , Roeyen Geert , Sanchez-Bueno Francisco , Serrablo Alejandro , Sparrelid Ernesto , Tepetes Konstantinos , Thakkar Rohan G. , Tzimas George N. , Verdonk Robert C. , ten Winkel Meike , Zerbi Alessandro , Groot Vincent P. , Molenaar I. Quintus , Daamen Lois A. , van Santvoort Hjalmar C. ,   European-African Hepato-Pancreato-Biliary Association, Ammar Khaled , Busch Olivier R. , Eijck Casper H.J. , Fusai Giuseppe Kito , Hartman Vera , Hingh Ignace H. , Jamieson Nigel B. , Kirbes Klaus , Llàcer-Millán Erik , Martino Marcello , Mentor Keno , Nappo  Gennaro  , Pedro Gomes  Antonio  , Perivoliotis Konstantinos , Uzunoglu Faik G. , Wellner Ulrich 
Published: November 2024

Importance

International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.

Objective

To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).

Design, Setting, and Participants

This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.

Exposures

Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.

Main Outcomes and Measures

Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.

Results

Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).

Conclusion and Relevance

In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.