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
ARTICLE HIGHLIGHTS
Research background

Excluding common etiologies, the onset of acute pancreatitis (AP) may be due to cancer progression itself or to complications of the diagnostic and therapeutic interventional procedures used in pancreatic ductal adenocarcinoma (PDAC) treatment, such as endoscopic retrograde cholangiopancreatography (ERCP), surgery and chemotherapy. Generally, PDAC patients with AP should initially be managed conservatively. However, surgical resection is the sole curative measure for pancreatic cancer, and conservative treatments can significantly delay the need for the cancer operation.

Research motivation

Many studies have shown that AP has significant negative effects on prognosis and outcome of PDAC. However, only a few studies have evaluated the overall survival of patients with pancreatic cancer and AP, and the impact of AP on tumor-specific survival has not been thoroughly understood.

Research objectives

The main objectives of this study were to investigate the effect of AP on the tumor recurrence pattern of PDAC and tumor-specific survival.

Research methods

The clinical data of 274 patients with PDAC who underwent curative resection at our center from July 2012 to December 2016 were analyzed retrospectively. Patients with mild AP were excluded because they experience a mild clinical course. The remaining 219 cases were subdivided into two groups. Group AP [n = 21 (9.6%)] included those patients with moderate or severe acute pancreatitis and group non-AP [n = 198 (90.4%)] included those without acute pancreatitis. Overall survival was defined as the time from the date of surgery to death or last follow-up. Postoperative tumor recurrence within 12 mo was regarded as early recurrence. The median follow-up time was 18.3 mo. Postoperative recurrence was diagnosed by imaging studies. We obtained postoperative recurrence data for only 186 of 219 patients.

Research results

Moderate or severe AP was an independent risk factor for an early recurrence of PDAC. Moderate or severe AP was an independent prognostic factor for overall survival and disease-free survival in patients with PDAC.

Research conclusions

PDAC patients with moderate or severe AP developed recurrences earlier and had shorter tumor-specific survival than those without.

Research perspectives

We should reduce the incidence of ERCP related to AP of PDAC . When accompanied with AP, PDAC should be timely diagnosed and surgical intervention should be performed in order to improve the oncological outcomes. Further prospective and multi-center studies are needed to verify our conclusions.