In Reply The secondary analysis of European Study Group for Pancreatic Cancer 4 (ESPAC-4) demonstrated that there were no significant differences between the time to recurrence and subsequent and overall survival between local and distant recurrence.1 Patients with metastases to the lungs had a much longer survival compared with those with local recurrence or metastases to other sites such as the liver. Thus, it is clear that pancreatic cancer appears to behave as a systemic disease requiring effective systemic therapy after resection.
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Neoptolemos JP, Jones RP, Büchler MW. Recurrence After Resection of Pancreatic Ductal Adenocarcinoma—Reply. JAMA Surg. Published online January 02, 2020. doi:10.1001/jamasurg.2019.5465
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