Second-look operation for unresectable pancreatic ductal adenocarcinoma at a high-volume center

Ann Surg Oncol. 2008 Jan;15(1):186-92. doi: 10.1245/s10434-007-9535-0. Epub 2007 Oct 18.


Background: The value of re-exploration for pancreatic ductal adenocarcinoma after the initial diagnosis of unresectability is unclear.

Methods: In this study, we analyzed 33 patients who were re-explored after an initial diagnosis of unresectability.

Results: At the time of reoperation, a resectable tumor was found in 18 patients: therefore, 15 pancreaticoduodenectomies, two total pancreatectomies and one left resection were performed with three vascular resections. Morbidity and mortality rates for the cohort were 6/33 and 1/33, without significant differences between resectable and nonresectable patients. Length of stay, duration of operation, and blood loss were significantly increased in the resection group. Kaplan-Meier survival analysis demonstrated increased median survival for resected patients (1078 days after the initial operation versus 547 days in the group of unresectable patients; p = 0.018). Analysis of the reasons against initial resection showed that, if the patients had been sent to a tertiary referral center for pancreatic surgery, a different decision in favor of resection would probably have been made in 14 out of 33 patients. A review of 10 published reports on reoperation for pancreatic cancer revealed results comparable to our study in terms of low morbidity and mortality as well as a survival benefit.

Conclusions: Reoperation for pancreatic ductal adenocarcinoma that is initially deemed unresectable can be safely performed in a selected group of patients by experienced surgeons, supporting the concept of patient centralization in pancreatic surgery. Resection at the second operation may confer a survival benefit even when the initial findings preclude a potentially curative approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Carcinoma, Pancreatic Ductal / pathology
  • Carcinoma, Pancreatic Ductal / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatectomy*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy*
  • Prospective Studies
  • Reoperation
  • Retrospective Studies
  • Second-Look Surgery*
  • Survival Rate