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Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma
PCM. Andel, IWJM. van Goor, S. Augustinus, F. Berrevoet, MG. Besselink, R. Bhojwani, U. Boggi, SAW. Bouwense, GA. Cirkel, JL. van Dam, A. Djanani, D. Dorcaratto, S. Dreyer, M. den Dulk, I. Frigerio, P. Ghorbani, MR. Goetz, B. Groot Koerkamp, F....
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Carcinoma, Pancreatic Ductal * surgery mortality diagnostic imaging pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasm Recurrence, Local * MeSH
- Survival Rate MeSH
- Pancreatic Neoplasms * surgery mortality MeSH
- Follow-Up Studies MeSH
- Pancreatectomy * MeSH
- Prospective Studies MeSH
- Cross-Sectional Studies MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
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 of Surgery UKSH Campus Lübeck Lübeck Germany
Department of Academic Surgery Glasgow Royal Infirmary Glasgow United Kingdom
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 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 Medical Oncology University Medical Center Utrecht Utrecht the Netherlands
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 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 Royal Free Hospital London United Kingdom
Department of Surgery University Hospital of Larissa Larissa Greece
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
References provided by Crossref.org
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- $a Andel, Paul C M $u Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St Antonius Hospital Nieuwegein, Utrecht, the Netherlands
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- $a Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma / $c PCM. Andel, IWJM. van Goor, S. Augustinus, F. Berrevoet, MG. Besselink, R. Bhojwani, U. Boggi, SAW. Bouwense, GA. Cirkel, JL. van Dam, A. Djanani, D. Dorcaratto, S. Dreyer, M. den Dulk, I. Frigerio, P. Ghorbani, MR. Goetz, B. Groot Koerkamp, F. Gryspeerdt, C. Hidalgo Salinas, M. Intven, JR. Izbicki, R. Jorba Martin, EF. Kauffmann, R. Klug, MSL. Liem, MDP. Luyer, M. Maglione, E. Martin-Perez, M. Meerdink, VE. de Meijer, VB. Nieuwenhuijs, A. Nikov, V. Nunes, E. Pando, D. Radenkovic, G. Roeyen, F. Sanchez-Bueno, A. Serrablo, E. Sparrelid, K. Tepetes, RG. Thakkar, GN. Tzimas, RC. Verdonk, M. Ten Winkel, A. Zerbi, VP. Groot, IQ. Molenaar, LA. Daamen, HC. van Santvoort, European-African Hepato-Pancreato-Biliary Association
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- $a 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.
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