Predicting post-recurrence survival for patients with pancreatic cancer recurrence after primary resection: A Bi-institutional validated risk classification.

BACKGROUND: Over 80% of patients will develop disease recurrence after radical resection of pancreatic ductal adenocarcinoma (PDAC). This study aims to develop and validate a clinical risk score predicting post-recurrence survival (PRS) at time of recurrence. METHODS: All patients who had recurrence after undergoing pancreatectomy for PDAC at the Johns Hopkins Hospital or at the Regional Academic Cancer Center Utrecht during the study period were included. Cox proportional hazard model was used to develop the risk model. Performance of the final model was assessed in a test set after internal validation. RESULTS: Of 718 resected PDAC patients, 72% had recurrence after a median follow-up of 32 months. The median overall survival was 21 months and the median PRS was 9 months. Prognostic factors associated with shorter PRS were age (hazard ratio [HR] 1.02; 95% confidence interval [95%CI] 1.00-1.04), multiple-site recurrence (HR 1.57; 95%CI 1.08-2.28), and symptoms at time of recurrence (HR 2.33; 95%CI 1.59-3.41). Recurrence-free survival longer than 12 months (HR 0.55; 95%CI 0.36-0.83), FOLFIRINOX and gemcitabine-based adjuvant chemotherapy (HR 0.45; 95%CI 0.25-0.81; HR 0.58; 95%CI 0.26-0.93, respectively) were associated with a longer PRS. The resulting risk score had a good predictive accuracy (C-index: 0.73). CONCLUSION: This study developed a clinical risk score based on an international cohort that predicts PRS in patients who underwent surgical resection for PDAC. This risk score will become available on www.evidencio.com and can help clinicians with patient counseling on prognosis.

Pancreatoduodenectomy for distal cholangiocarcinoma 13 years after oesophagectomy with gastric tube reconstruction: report of a case.

Advancements in cancer management have led to improved survival in patients with oesophageal cancer. This has resulted in an increased incidence of second primary malignancies with the pancreas as a common secondary cancer site. Resectable pancreatic and periampullary cancers are treated by pancreatoduodenectomy, including resection of the gastroduodenal artery which provides the blood supply to the gastric conduit in patients who underwent oesophagectomy. A 77-year-old man with a history of distal oesophageal cancer, for which an oesophagectomy with gastric tube reconstruction was performed, presented in the emergency department. Extensive workup showed a lesion suspected for a distal cholangiocarcinoma. Pancreatoduodenectomy was deemed feasible after arterial angiography revealed that the gastric conduit was dominantly vascularised by the right gastric artery. Adequate imaging of the blood supply is essential to determine eligibility for pancreatoduodenectomy in patients with a second primary malignancy in the pancreas or periampullary region after oesophagectomy with gastric tube reconstruction.