Learning Curve Effect in Reducing Local Recurrence Rate After Resection of Pancreatic Cancer With Arterial Abutment:...

Pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) with arterial abutment is a complex, high-risk surgery. We aimed to investigate the clinicopathological features, risk factors, and learning curve for local recurrence after pancreatectomy for PDAC with arterial abutment.

Sixty consecutive patients who underwent pancreatectomy for borderline resectable and locally advanced PDAC with arterial abutment at Kobe University Hospital between 2010 and 2020 were enrolled in this retrospective study. Logistic regression analysis was performed to investigate the risk factors for local recurrence. The local recurrence rate was examined for every 10 cases over time.

Eighteen (30.0%) patients developed local recurrence; 12 (20.0%) developed local-only recurrence, and six (10.0%) developed local and other recurrences. The median survival time after surgery was similar between patients with local-only (n = 12) and other recurrences (n = 31) (18.9 vs. 17.3 months, p = 0.650). The local recurrence rate was significantly lower during the late period than during the early period (13.3% vs. 46.7%, respectively). In the multivariate analyses, the operative period (odds ratio, 7.01; 95% CI: 1.09-45.2; p = 0.041) was the independent factor associated with local recurrence. The local recurrence rate in the first 10 patients was 70%, but it gradually decreased to 10% in the last 10 patients.

Local recurrence has a significant impact on survival, as do other recurrences after pancreatectomy for PDAC with arterial abutment. A learning curve may exist for the local recurrence rate, suggesting that it should be performed by experienced surgical teams at high-volume centers.