Routine Imaging After Resection of Pancreatic Ductal Adenocarcinoma: Nationwide Utilization and Survival Analysis

Iris W J M van Goor ^1,2, Paul C M Andel ¹, Simone Augustinus ^3,4

¹Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands.
²Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.
³Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
⁴Cancer Center Amsterdam, the Netherlands.
⁵Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
⁶Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
⁷Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & Meander Medical Center Amersfoort, Utrecht, the Netherlands.
⁸Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands.
⁹Department of Surgery, OLVG, Amsterdam, the Netherlands.
¹⁰Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
¹¹Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
¹²Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
¹³Amsterdam UMC, location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands.
¹⁴Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
¹⁵Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
¹⁶Department of Surgery, Isala, Zwolle, the Netherlands.
¹⁷Department of Surgery, Renier de Graaf Gasthuis, Delft, the Netherlands.
¹⁸Department of Surgery, Amphia Hospital, Breda, the Netherlands.
¹⁹Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
²⁰Department of Surgery, Tjongerschans Hospital, Heerenveen, the Netherlands.
²¹Department of Gastroenterology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.
²²Imaging Division, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.

⁰Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands.

Annals of Surgery +

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June 3, 2025

View abstract on PubMed

Summary

Routine imaging after pancreatic ductal adenocarcinoma (PDAC) resection improves survival by detecting asymptomatic recurrence and enabling timely treatment. This supports its inclusion in clinical guidelines for better patient outcomes.

Area Of Science

Oncology
Surgical Oncology
Medical Imaging

Background

Limited evidence exists on the benefits of routine imaging post-pancreatic ductal adenocarcinoma (PDAC) resection for detecting recurrence.
Increased availability of effective PDAC recurrence treatments may drive routine imaging use.

Purpose Of The Study

To assess the utilization of routine imaging after PDAC resection.
To evaluate the impact of routine imaging on survival outcomes in PDAC patients.

Main Methods

Nationwide observational cohort study of PDAC resection patients in the Netherlands (2014-2019).
Stratification based on surveillance strategy (routine imaging vs. symptomatic surveillance).
Analysis of overall survival (OS), asymptomatic recurrence, and recurrence treatment using Kaplan-Meier, logistic regression, and Cox proportional hazard models.

Main Results

1311 patients included; 11% received routine imaging.
Routine imaging group had significantly longer median OS (43 months) vs. symptomatic surveillance (22 months).
Routine imaging was associated with higher rates of asymptomatic recurrence, recurrence treatment, and improved OS.

Conclusions

Routine imaging after PDAC resection is independently linked to detecting asymptomatic recurrence and improved survival.
Findings support the integration of routine imaging into clinical guidelines for post-PDAC resection care.

Keywords:

disease recurrence pancreatic cancer pancreatic cancer resection postoperative surveillance strategy