Routine Imaging After Resection of Pancreatic Ductal Adenocarcinoma

Objective: To evaluate the utilization of routine imaging and the impact on survival after resection of pancreatic ductal adenocarcinoma (PDAC). Background: Evidence on the benefit of routine imaging after resection of PDAC on early detection and treatment of disease recurrence is currently lacking. The availability of more effective treatment options for PDAC recurrence may have increased the utilization of routine imaging in daily clinical practice. Methods: Patients who underwent resection of PDAC in the Netherlands (2014-2019) were included in this nationwide observational cohort study (NCT04605237). Patients were stratified based on surveillance strategy. Median overall survival (OS) was assessed using Kaplan-Meier survival curves. The association between surveillance strategy and asymptomatic recurrence, recurrence treatment, and OS was assessed using multivariable logistic regression and Cox proportional hazard analysis, respectively. Results: A total of 1311 patients were included, with a median follow-up of 45 (IQR 34-61) months. Routine imaging was used in 139 patients (11%), with a median OS of 43 (IQR 35-not reached) months, compared to 22 (IQR 21-24) months in 1172 patients (89%) with a symptomatic surveillance ( P <0.001). Routine imaging was associated with asymptomatic recurrence (OR 3.79 [95% CI 2.27-6.32]; P <0.001), recurrence treatment (OR 2.50 [95% CI 1.21-5.18]; P =0.01) and improved OS (HR 0.56 [95% CI 0.44-0.71]; P <0.001). Conclusion: Routine imaging after resection of PDAC was independently associated with the detection of asymptomatic disease recurrence, recurrence treatment and improved survival, which further advocates towards inclusion of routine imaging after PDAC resection in clinical guidelines.