Recurrence of exocrine pancreatic cancer--local or hepatic?

The results of radical surgery for pancreatic cancer depend, like all other cancer surgery, on the technique used, and the biology of the disease. We have analysed the site and time of recurrence after pancreatectomy for exocrine pancreatic cancer in 74 patients who died more than six months postoperatively. All patients had recurrent disease, 64 patients had local recurrence in the pancreatic bed and 68 had liver metastases. Local recurrence without liver metastases was found in six patients, and ten had liver metastases, but no local recurrence. Both the time from operation to clinically evident recurrence and the postoperative survival time were significantly longer for patients with local recurrence only. Although not statistically significant, there was a tendency (5 out of 8) for smaller, well-differentiated tumors without spread outside the pancreas to be associated with local recurrences without liver metastases. We conclude that, in retrospect, the surgical procedures used were inappropriate and inadequate. To cure these patients, a more radical operation and/or effective adjuvant treatment is needed.