Recurrence Following Resection of Pancreatic Cancer

Disease recurrence after resection of pancreatic cancer unfortunately remains common and marks a critical and emotional time point in the care of these patients. A more accurate understanding of disease failure after seemingly successful surgery is deemed essential in the pursuit of improved survival for pancreatic cancer patients. The current thesis aims to provide an extensive comprehension of multiple aspects of pancreatic cancer recurrence following resection. Part I shows that the timing and location of recurrence are associated with different survival outcomes, suggesting that biologic heterogeneity exists among pancreatic cancer recurrences. Part II highlights that although the new paradigm of neoadjuvant therapy can lead to more patients being eligible for resection, recurrence rates remain high. Part III discusses the low quality and contradictory evidence that leads to varying follow-up practices and guidelines for the detection of recurrence. Part IIIa studies the performance and role of imaging during post-operative surveillance, while Part IIIb considers the value of biomarkers for the detection of recurrence PDAC. Included Part IIIb are two prospective longitudinal studies that prove the clinical utility of both circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) in this setting. Lastly, Part IV portrays the potential of individualized treatment of recurrent disease, based on experiences with local and pulmonary recurrence