Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2019; 25(39): 6006-6015
Published online Oct 21, 2019. doi: 10.3748/wjg.v25.i39.6006
Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis
Qian Feng, Cheng Li, Sheng Zhang, Chun-Lu Tan, Gang Mai, Xu-Bao Liu, Yong-Hua Chen
Qian Feng, Chun-Lu Tan, Xu-Bao Liu, Yong-Hua Chen, Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Cheng Li, Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Sheng Zhang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, Henan Province, China
Gang Mai, Department of Hepatobiliary Surgery, Deyang People's Hospital, Deyang 618000, Sichuan Province, China
Author contributions: Feng Q and Li C contributed equally to this paper. Chen YH, Mai G and Liu XB designed the research; Li C, Feng Q, Zhang S, Tan CL and Chen YH performed research and analyzed data; Feng Q, Li C and Chen YH wrote the manuscript. All authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81602133; the Key Research and Development Projects in Sichuan Province, No. 2019YFS0043; and the Scientific and Technological Support Program of Sichuan Province, No. 2016FZ0115.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of West China Hospital at Sichuan University.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong-Hua Chen, MD, PhD, Doctor, Surgeon, Department of Pancreatic Surgery, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China. chenyonghua2007@163.com
Telephone: +86-28-85422474
Received: August 4, 2019
Peer-review started: August 4, 2019
First decision: August 27, 2019
Revised: September 12, 2019
Accepted: September 27, 2019
Article in press: September 27, 2019
Published online: October 21, 2019
Processing time: 77 Days and 17.6 Hours
Abstract
BACKGROUND

In pancreatic cancer, acute pancreatitis (AP) is a serious morbidity, but its negative effect on long-term outcomes remains to be elucidated.

AIM

To investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma (PDAC) and tumor-specific survival.

METHODS

The medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively. The severity of acute pancreatitis was classified according to the Atlanta classification of AP. The patient demographics and tumor characteristics were assessed. Early recurrence was defined as a relapse within 12 mo after surgery. Overall and disease-free survival and recurrence patterns were analyzed. Mild acute pancreatitis was excluded because its negative effects can be negligible.

RESULTS

Early recurrence in AP group was significantly higher than in non-AP group (71.4% vs 41.2%; P = 0.009). Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence [odds ratio (OR): 4.13; 95% confidence interval (CI): 1.41-12.10; P = 0.01]. The median time to recurrence was shorter in patients with AP than in those without (8.4 vs 12.8 mo; P = 0.003). Multivariate analysis identified AP as an independent prognostic factor for overall survival [relative risk (RR): 2.35; 95%CI: 1.45-3.83] and disease-free survival (RR: 2.24; 95%CI: 1.31-3.85) in patients with PDAC.

CONCLUSION

Patients with moderate or severe acute pancreatitis developed recurrences earlier than those without. Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.

Keywords: Acute pancreatitis; Pancreatic ductal adenocarcinoma; Recurrence; Prognosis; Overall survival; Disease-free survival

Core tip: This study investigated the effects of acute pancreatitis (AP) on the tumor recurrence pattern of pancreatic ductal adenocarcinoma (PDAC) and tumor-specific survival. We found that moderate or severe AP was significantly related to early recurrence, and patients with moderate or severe AP developed recurrence earlier than those without. Moderate or severe AP was adversely correlated with overall and disease-free survival of patients with PDAC. Surgeons are thus urged to reduce the complications of endoscopic retrograde cholangiopancreatography and make efforts to diagnose PDAC timely in patients who present with AP in order to improve the oncological outcomes of PDAC.