Surgery for recurrence of periampullary malignancies

Few studies have addressed the surgical treatment of recurrent disease after pancreatic resection. The aim of this study was to evaluate the indications, the short- and long-term outcome, and the prognostic factors impacting survival in patients undergoing a re-laparotomy for recurrence of periampullary malignancies.

Between 1990 and 2007, 16 re-laparotomies were performed in 15 patients (one patient had a second re-laparotomy) with a median age of 61 years (range 31-84). Patients were identified from a prospective database and records were reviewed retrospectively.

Seven re-laparotomies were performed for a surgical emergency and nine patients had a re-laparotomy for recurrence found at imaging studies. Perioperative mortality was observed in three patients presenting with surgical emergency and a poor performance status (Eastern Cooporative Oncology Group score >or=3). Perioperative morbidity was 40%. Median survival after the first re-laparotomy for the 15 patients was 7.4 months, and was not different for patients presenting a surgical emergency versus no emergency. Patients with peritoneal carcinomatosis had a median survival of 1.4 month. In a univariate analysis of survival, a performance status of ECOG score >or=2 and a pre-operative hemoglobin level <12 g/dl were predictors of poor survival.

In selected patients, a re-laparotomy for recurrence of periampullary malignancies is feasible. Peritoneal recurrence was not a good indication for surgery. The predictors of poor survival after the re-laparotomy were a poor performance status and a low preoperative hemoglobin level.