HPB SO43 - Meta-analysis of completion pancreatectomy for local recurrence of pancreatic cancer after the index pancreatectomy

Abstract Background Poor prognosis post-resection of pancreatic cancer is owed to a high rates of cancer recurrence (approximately 80%) despite complete surgical resection being achieved. The role of surgical re-resection in patients with recurrent pancreatic cancer is unclear. Several studies have reported survival benefit of repeat pancreatectomy for selected patients with local recurrence in the remnant pancreas after the index pancreatectomy. We aimed to conduct a comprehensive systematic review and meta-analysis of best available evidence to evaluate survival outcomes of completion pancreatectomy for locally recurrent pancreatic cancer following index pancreatectomy. Method A systematic search of electronic data sources and bibliographic reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data. Results Fifteen retrospective studies were included reporting a total of 250 patients who underwent completion pancreatectomy for locally recurrent pancreatic cancer following their index pancreatectomy. Completion pancreatectomy was associated with 1-year survival of 70.6% (95% CI 65.0%-76.2%), 2-year survival of 38.8% (95% CI 28.6%-49.0%), 3-year survival of 20.2% (95% CI 13.8%-26.7%), and 5-year survival of 9.2% (95% CI 5.5%-12.8%). The between-study heterogeneity was insignificant in all outcome syntheses. Conclusion Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favourable tumour size and location. Our findings may encourage conduction of better-quality studies in this context to provide stronger evidence.