Early recurrence of pancreatic cancer: modern criteria for "futility of surgery"

The recurrence rate within 12 months after surgery for pancreatic cancer (PCa) reaches 48 %. The concept of "futile sur gery" emphasizes that performing surgery without prior risk stratification not only fails to improve the prognosis but also increases the incidence of complications and reduces quality of life.

Purpose of the study. To analyze current data on criteria for early recurrence of PCa, their prognostic significance, and potential use as a tool for selecting patients for surgical treatment.

Materials and methods. A search was conducted in PubMed, Scopus, Web of Science, and Elibrary.ru from January 2019 to March 2026. The following keywords were used: "pancreatic ductal adenocarcinoma", "early recurrence", "futile surgery", "CA 19-9", "neoadjuvant therapy", "predictive model", "staging laparoscopy". Cohort studies, meta-analyses, systematic reviews, and clinical guidelines were included; isolated case reports, small series (<10 patients), experimental studies, and publications without a clear definition of early recurrence were excluded.

Results. The most significant preoperative predictors of early recurrence were elevated CA 19-9 levels (cutoffs from 97 to 210 U/mL), tumor size >3 cm, lymph node metastases, R1 resection, low grade of differentiation (G3), and the absence of adjuvant chemotherapy. Prognostic scores were developed and validated to stratify the risk of "futile surgery".

Conclusion. Early recurrence is a marker of "futile surgery". Multidisciplinary assessment using prognostic models, staging laparoscopy, and neoadjuvant therapy allows us to identify a high-risk group in which avoiding primary surgery does not worsen the prognosis but reduces the incidence of complications and improves quality of life. Further development of this approach requires prospective validation of existing scoring systems and the introduction of molecular genetic markers.

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