Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

Paul C M Andel; Iris W J M van Goor; Simone Augustinus; Frederik Berrevoet; Marc G Besselink; Rajesh Bhojwani; Ugo Boggi; Stefan A W Bouwense; Geert A Cirkel; Jacob L van Dam; Angela Djanani; Dimitri Dorcaratto; Stephan Dreyer; Marcel den Dulk; Isabella Frigerio; Poya Ghorbani; Mara R Goetz; Bas Groot Koerkamp; Filip Gryspeerdt; Camila Hidalgo Salinas; Martijn Intven; Jakob R Izbicki; Rosa Jorba Martin; Emanuele F Kauffmann; Reinhold Klug; Mike S L Liem; Misha D P Luyer; Manuel Maglione; Elena Martin-Perez; Mark Meerdink; Vincent E de Meijer; Vincent B Nieuwenhuijs; Andrej Nikov; Vitor Nunes; Elizabeth Pando Rau; Dejan Radenkovic; Geert Roeyen; Francisco Sanchez-Bueno; Alejandro Serrablo; Ernesto Sparrelid; Konstantinos Tepetes; Rohan G Thakkar; George N Tzimas; Robert C Verdonk; Meike Ten Winkel; Alessandro Zerbi; Vincent P Groot; I Quintus Molenaar; Lois A Daamen; Hjalmar C van Santvoort; European-African Hepato-Pancreato-Biliary Association

doi:10.1001/jamasurg.2024.5024

Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

Paul C M Andel, Iris W J M van Goor, Simone Augustinus, Frederik Berrevoet, Marc G Besselink, Rajesh Bhojwani, Ugo Boggi, Stefan A W Bouwense, Geert A Cirkel, Jacob L van Dam, Angela Djanani, Dimitri Dorcaratto, Stephan Dreyer, Marcel den Dulk, Isabella Frigerio, Poya Ghorbani, Mara R Goetz, Bas Groot Koerkamp, Filip Gryspeerdt, Camila Hidalgo SalinasMartijn Intven, Jakob R Izbicki, Rosa Jorba Martin, Emanuele F Kauffmann, Reinhold Klug, Mike S L Liem, Misha D P Luyer, Manuel Maglione, Elena Martin-Perez, Mark Meerdink, Vincent E de Meijer, Vincent B Nieuwenhuijs, Andrej Nikov, Vitor Nunes, Elizabeth Pando Rau, Dejan Radenkovic, Geert Roeyen, Francisco Sanchez-Bueno, Alejandro Serrablo, Ernesto Sparrelid, Konstantinos Tepetes, Rohan G Thakkar, George N Tzimas, Robert C Verdonk, Meike Ten Winkel, Alessandro Zerbi, Vincent P Groot, I Quintus Molenaar, Lois A Daamen, Hjalmar C van Santvoort^*, European-African Hepato-Pancreato-Biliary Association

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

IMPORTANCE: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. OBJECTIVE: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. EXPOSURES: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. MAIN OUTCOMES AND MEASURES: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. RESULTS: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). CONCLUSION AND RELEVANCE: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

Original language	English
Pages (from-to)	74-84
Number of pages	11
Journal	JAMA Surgery
Volume	160
Issue number	1
Early online date	6 Nov 2024
DOIs	https://doi.org/10.1001/jamasurg.2024.5024
Publication status	Published - 1 Jan 2025

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10.1001/jamasurg.2024.5024

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Andel, P. C. M., van Goor, I. W. J. M., Augustinus, S., Berrevoet, F., Besselink, M. G., Bhojwani, R., Boggi, U., Bouwense, S. A. W., Cirkel, G. A., van Dam, J. L., Djanani, A., Dorcaratto, D., Dreyer, S., den Dulk, M., Frigerio, I., Ghorbani, P., Goetz, M. R., Groot Koerkamp, B., Gryspeerdt, F., ... European-African Hepato-Pancreato-Biliary Association (2025). Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma. JAMA Surgery, 160(1), 74-84. https://doi.org/10.1001/jamasurg.2024.5024

@article{c8bf91edba8f4c63b1e931f2fa74a3f1,

title = "Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma",

abstract = "IMPORTANCE: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. OBJECTIVE: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. EXPOSURES: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. MAIN OUTCOMES AND MEASURES: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. RESULTS: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). CONCLUSION AND RELEVANCE: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.",

author = "Andel, {Paul C M} and {van Goor}, {Iris W J M} and Simone Augustinus and Frederik Berrevoet and Besselink, {Marc G} and Rajesh Bhojwani and Ugo Boggi and Bouwense, {Stefan A W} and Cirkel, {Geert A} and {van Dam}, {Jacob L} and Angela Djanani and Dimitri Dorcaratto and Stephan Dreyer and {den Dulk}, Marcel and Isabella Frigerio and Poya Ghorbani and Goetz, {Mara R} and {Groot Koerkamp}, Bas and Filip Gryspeerdt and {Hidalgo Salinas}, Camila and Martijn Intven and Izbicki, {Jakob R} and {Jorba Martin}, Rosa and Kauffmann, {Emanuele F} and Reinhold Klug and Liem, {Mike S L} and Luyer, {Misha D P} and Manuel Maglione and Elena Martin-Perez and Mark Meerdink and {de Meijer}, {Vincent E} and Nieuwenhuijs, {Vincent B} and Andrej Nikov and Vitor Nunes and {Pando Rau}, Elizabeth and Dejan Radenkovic and Geert Roeyen and Francisco Sanchez-Bueno and Alejandro Serrablo and Ernesto Sparrelid and Konstantinos Tepetes and Thakkar, {Rohan G} and Tzimas, {George N} and Verdonk, {Robert C} and {Ten Winkel}, Meike and Alessandro Zerbi and Groot, {Vincent P} and Molenaar, {I Quintus} and Daamen, {Lois A} and {van Santvoort}, {Hjalmar C} and {European-African Hepato-Pancreato-Biliary Association}",

year = "2025",

month = jan,

day = "1",

doi = "10.1001/jamasurg.2024.5024",

language = "English",

volume = "160",

pages = "74--84",

journal = "JAMA Surgery",

issn = "2168-6254",

publisher = "American Medical Association",

number = "1",

}

Andel, PCM, van Goor, IWJM, Augustinus, S, Berrevoet, F, Besselink, MG, Bhojwani, R, Boggi, U, Bouwense, SAW, Cirkel, GA, van Dam, JL, Djanani, A, Dorcaratto, D, Dreyer, S, den Dulk, M, Frigerio, I, Ghorbani, P, Goetz, MR, Groot Koerkamp, B, Gryspeerdt, F, Hidalgo Salinas, C, Intven, M, Izbicki, JR, Jorba Martin, R, Kauffmann, EF, Klug, R, Liem, MSL, Luyer, MDP, Maglione, M, Martin-Perez, E, Meerdink, M, de Meijer, VE, Nieuwenhuijs, VB, Nikov, A, Nunes, V, Pando Rau, E, Radenkovic, D, Roeyen, G, Sanchez-Bueno, F, Serrablo, A, Sparrelid, E, Tepetes, K, Thakkar, RG, Tzimas, GN, Verdonk, RC, Ten Winkel, M, Zerbi, A, Groot, VP, Molenaar, IQ, Daamen, LA, van Santvoort, HC & European-African Hepato-Pancreato-Biliary Association 2025, 'Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma', JAMA Surgery, vol. 160, no. 1, pp. 74-84. https://doi.org/10.1001/jamasurg.2024.5024

TY - JOUR

T1 - Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

AU - Andel, Paul C M

AU - van Goor, Iris W J M

AU - Augustinus, Simone

AU - Berrevoet, Frederik

AU - Besselink, Marc G

AU - Bhojwani, Rajesh

AU - Boggi, Ugo

AU - Bouwense, Stefan A W

AU - Cirkel, Geert A

AU - van Dam, Jacob L

AU - Djanani, Angela

AU - Dorcaratto, Dimitri

AU - Dreyer, Stephan

AU - den Dulk, Marcel

AU - Frigerio, Isabella

AU - Ghorbani, Poya

AU - Goetz, Mara R

AU - Groot Koerkamp, Bas

AU - Gryspeerdt, Filip

AU - Hidalgo Salinas, Camila

AU - Intven, Martijn

AU - Izbicki, Jakob R

AU - Jorba Martin, Rosa

AU - Kauffmann, Emanuele F

AU - Klug, Reinhold

AU - Liem, Mike S L

AU - Luyer, Misha D P

AU - Maglione, Manuel

AU - Martin-Perez, Elena

AU - Meerdink, Mark

AU - de Meijer, Vincent E

AU - Nieuwenhuijs, Vincent B

AU - Nikov, Andrej

AU - Nunes, Vitor

AU - Pando Rau, Elizabeth

AU - Radenkovic, Dejan

AU - Roeyen, Geert

AU - Sanchez-Bueno, Francisco

AU - Serrablo, Alejandro

AU - Sparrelid, Ernesto

AU - Tepetes, Konstantinos

AU - Thakkar, Rohan G

AU - Tzimas, George N

AU - Verdonk, Robert C

AU - Ten Winkel, Meike

AU - Zerbi, Alessandro

AU - Groot, Vincent P

AU - Molenaar, I Quintus

AU - Daamen, Lois A

AU - van Santvoort, Hjalmar C

AU - European-African Hepato-Pancreato-Biliary Association

PY - 2025/1/1

Y1 - 2025/1/1

N2 - IMPORTANCE: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. OBJECTIVE: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. EXPOSURES: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. MAIN OUTCOMES AND MEASURES: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. RESULTS: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). CONCLUSION AND RELEVANCE: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

AB - IMPORTANCE: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. OBJECTIVE: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. EXPOSURES: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. MAIN OUTCOMES AND MEASURES: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. RESULTS: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). CONCLUSION AND RELEVANCE: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

U2 - 10.1001/jamasurg.2024.5024

DO - 10.1001/jamasurg.2024.5024

M3 - Article

SN - 2168-6254

VL - 160

SP - 74

EP - 84

JO - JAMA Surgery

JF - JAMA Surgery

IS - 1

ER -

Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

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