Clinical impact of structured post-operative surveillance in resected pancreatic adenocarcinoma: Results from a retrospective cohort study

Introduction
To this date, surgery remains the only potentially curative approach in the treatment of pancreatic cancer. To analyse the clinical impact of a structured post-operative follow-up program, we retrospectively analysed a cohort of resected pancreatic adenocarcinoma patients treated at LMU Munich.

Methods
Pancreatic adenocarcinoma patients who underwent resection and presented for regular follow-up visits at our center between 2002 and 2017 were identified from two existing study cohorts. Diagnosis of recurrences was categorized by timing (within or outside a scheduled follow up visit) and detection modality (imaging, CA 19-9 increase, or clinical deterioration) and correlated with disease-free survival (DFS) and overall survival (OS).

Results
One-hundred and twenty-five patients with resected pancreatic adenocarcinoma were included in this analysis. Median OS in the whole cohort was 21.1 months. Of these 125 patients, 103 (82.4%) had a documented relapse. Tumour recurrences detected within a scheduled follow up visit (n=86, 83.5%) compared to recurrences becoming apparent at an unplanned visit (n=17, 16.5%) were associated with a significantly improved OS (median 25.5 versus 20.2 months, p=0.019). Compared to patients with recurrence detected by clinical deterioration (n=4, 3.9%), patients with recurrences detected by imaging or laboratory abnormalities (n=99, 96.0%) had a longer median OS (24.8 versus 15.1 months, p=0.007).

Disscusion/Conclusion
A structured follow-up after PDAC resection may have an impact on patient outcome. Prospective trials are needed to evaluate the clinical impact of post-operative follow-up programs.