Information needs among patients and a surveillance strategy after surgery for pancreatic and periampullary cancer

Recommendations for surveillance after resection of pancreatic and periampullary cancer are based on low-level evidence.1 There is no consensus on the optimal follow-up. Ultimately, the decision regarding the intensiveness of follow-up is left to the discretion of the treating physician after discussion with the patient. Accordingly, the study by Deobald et al.2 on the attitude of patients and clinicians towards surveillance after a resection for pancreatic (n = 10) or periampullary (n = 5) cancer is highly appreciated. A question that needs to be raised, however, is whether, in this study, the lack of a distinction between pancreatic and periampullary cancer may have resulted in obfuscation of key prognostic information. There is a significant difference in the outcome between pancreatic, bile duct, ampullary and duodenal cancer.3 The information provided by the clinicians is guided by pathology-based tumour characteristics (cancer origin, intestinal or pancreatobiliary subtype, grade, resection margin and lymph node status).3 Currently, adjuvant treatment is recommended only for pancreatic adenocarcinoma. Furthermore, NCCN guidelines state that surveillance of pancreatic adenocarcinoma is based on the consensus that earlier detection of recurrence may facilitate patient recruitment to investigational treatment studies.1 Cancer origin is invariably a criterion for patient eligibility for clinical trials. Interestingly, two observational studies on systematic CT-based follow-up after potentially curative resection for pancreatic adenocarcinoma showed that patients with asymptomatic recurrence had improved survival and received oncological treatment more frequently.4,5 The detection of asymptomatic recurrence might be even more important in patients with often less aggressive periampullary tumours such as ampullary and duodenal adenocarcinoma.