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.

Amsterdam UMC location University of Amsterdam Department of Surgery Amsterdam the Netherlands

Cancer Center Amsterdam Amsterdam the Netherlands

Clinic for Digestive Surgery University Clinical Centra of Serbia Medical Faculty University of Belgrade Belgrade Serbia

Clinic of Surgery UKSH Campus Lübeck Lübeck Germany

Department of Academic Surgery Glasgow Royal Infirmary Glasgow United Kingdom

Department of General and Digestive Surgery Hospital Clínico Universitario Virgen de la Arrixaca Murcia Spain

Department of General and Digestive Surgery Miguel Servet University Hospital Zaragoza Spain

Department of General and Digestive Surgery University Hospital La Princesa Madrid Spain

Department of General and HPB Surgery and Liver Transplantation Ghent University Hospital Ghent Belgium

Department of General Visceral and Thoracic Surgery University Medical Center Hamburg Hamburg Germany

Department of General Visceral and Vascular Surgery Community Hospital Horn Horn Austria

Department of Hepato Pancreatobiliary and Transplant Surgery Hospital Vall d'Hebron Barcelona Spain

Department of HepatoPancreatoBiliary Surgery Hygeia Hospital Marousi Greece

Department of HPB Endocrine and Transplantation Surgery Antwerp University Hospital Antwerp Belgium

Department of Internal Medicine Gastroenterology Hepatology Endocrinology and Metabolism Medical University of Innsbruck Innsbruck Tyrol Austria

Department of Medical Oncology University Medical Center Utrecht Utrecht the Netherlands

Department of Pancreatic Surgery IRCCS Humanitas Hospital Rozzano and Humanitas University Pieve Emanuele Italy

Department of Radiation Oncology University Medical Center Utrecht Utrecht the Netherlands

Department of Surgery Catharina Hospital Eindhoven the Netherlands

Department of Surgery Erasmus Medical Center Rotterdam the Netherlands

Department of Surgery Hospital Clínico University of Valencia Biomedical Research Institute Valencia Spain

Department of Surgery Hospital Prof Doutor Fernando Fonseca EPE Amadora Portugal

Department of Surgery Hospital Universitari de Tarragona Joan XXIII Tarragona Spain

Department of Surgery Isala the Netherlands

Department of Surgery Karolinska Institutet Solna Sweden

Department of Surgery Maastricht University Medical Center Maastricht the Netherlands

Department of Surgery Medical Spectrum Twente Enschede the Netherlands

Department of Surgery Military University Hospital Prague Prague Czech Republic

Department of Surgery Newcastle Freeman Hospital Newcastle upon Tyne United Kingdom

Department of Surgery Regional Academic Cancer Center Utrecht UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein Utrecht the Netherlands

Department of Surgery Royal Free Hospital London United Kingdom

Department of Surgery Santokba Institute of Digestive Surgical Sciences Santokba Durlabhji Memorial Hospital Rajasthan India

Department of Surgery School of Nutrition and Translational Research in Metabolism Maastricht University Maastricht the Netherlands

Department of Surgery University Hospital of Larissa Larissa Greece

Department of Surgery University of Groningen and University Medical Center Groningen Groningen the Netherlands

Department of Translational Research on New Technologies in Medicine and Surgery University of Pisa Pisa Italy

Department of Visceral Transplant and Thoracic Surgery Medical University of Innsbruck Innsbruck Austria

Division of Imaging and Oncology University Medical Center Utrecht Utrecht the Netherlands

Institute of Cancer Sciences University of Glasgow Glasgow United Kingdom

Pancreatic Surgical Unit Pederzoli Hospital Peschiera del Garda Italy

Regional Academic Cancer Center Utrecht UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein Department of Gastroenterology Utrecht the Netherlands

Universitat Autonoma de Barcelona Barcelona Spain

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JAMA Surg. 2025 Jan 1;160(1):115. doi: 10.1001/jamasurg.2024.6210. PubMed

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