Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: an international multicentre retrospective cohort study
Labib, Peter L Z Russell, Thomas B Denson, Jemimah L Puckett, Mark A Ausania, Fabio Pando, Elizabeth Roberts, Keith J Kausar, Ambareen Mavroeidis, Vasileios K Bhogal, Ricky H
Labib, Peter L Z
Russell, Thomas B
Denson, Jemimah L
Puckett, Mark A
Ausania, Fabio
Pando, Elizabeth
Roberts, Keith J
Kausar, Ambareen
Mavroeidis, Vasileios K
Bhogal, Ricky H
Abstract
Background: Most patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) develop recurrence. No previous studies have investigated predictors of local-only recurrence following PD for PDAC. Our study aimed to determine timing, pattern and predictors of any-site and local-only recurrence following PD for PDAC.
Methods: Patients who underwent PD for PDAC between June 2012 and May 2015 (29 centres, eight countries) were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on demographics, comorbidities, investigations, operation details, complications, histology, adjuvant therapies, recurrence and survival. Univariable tests and regression analysis investigated factors associated with any-site and local-only recurrence.
Results: Of 866 patients, 573 (66 %) developed recurrence: 170 (20 %) developed local-only recurrence, 164 (19 %) developed mixed local/distant recurrence, and 239 (28 %) developed distant-only recurrence. Local-only or lung-only recurrence had a more favourable prognosis than other recurrence patterns. Predictors of any-site recurrence were preoperative biliary stenting, venous resection and poorly-differentiated, node-positive tumours. Predictors of local-only recurrence were preoperative radiological lymphadenopathy, well-differentiated tumours, fewer than 15 resected lymph nodes and intraoperative blood transfusion.
Discussion: Ensuring radical resection and avoiding intraoperative blood transfusion may reduce the risk of local-only recurrence following PD for PDAC.
Affiliations
University Hospitals Plymouth NHS Trust; Hospital Clínic de Barcelona; Hospital Universitari Vall d'Hebron; University Hospitals Birmingham NHS Foundation Trust; East Lancashire Hospital NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; Royal Marsden NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; NHS Lothian; Royal Surrey NHS Foundation Trust; Imperial College Healthcare NHS Trust; Hull University Teaching Hospitals NHS Trust; Medical University of Innsbruck; Ibn Sina Specialist Hospital; King's College Hospital NHS Foundation Trust; Shaukat Khanum Memorial Cancer Hospital; Leeds Teaching Hospitals NHS Trust; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Monash Medical Centre; Newcastle upon Tyne Hospitals NHS Foundation Trust; Nottingham University Hospitals NHS Trust; Oxford University Hospitals NHS Foundation Trust; Policlinico Umberto I Sapienza University of Rome; Royal Free London NHS Foundation Trust; Azienda Ospedaliero Universitaria di Sassari; Sheffield Teaching Hospitals NHS Foundation Trust; University Hospital Southampton Foundation Trust; Swansea Bay University Health Board; Hospital Universitario Miguel Servet
Date
2024-12-09
Type
Article
Subject
Citation
Labib PLZ, Russell TB, Denson JL, Puckett MA, Ausania F, Pando E, Roberts KJ, Kausar A, Mavroeidis VK, Bhogal RH, Marangoni G, Thomasset SC, Frampton AE, Spalding DR, Lykoudis P, Maglione M, Alhaboob N, Srinivasan P, Bari H, Smith A, Dominguez-Rosado I, Croagh D, Thakkar RG, Gomez D, Silva MA, Lapolla P, Mingoli A, Davidson BR, Porcu A, Shah NS, Hamady ZZ, Al-Sarireh BA, Serrablo A, Aroori S; RAW study collaborators. Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: an international multicentre retrospective cohort study. HPB (Oxford). 2025 Apr;27(4):445-460. doi: 10.1016/j.hpb.2024.11.015. Epub 2024 Dec 9