Factors influencing local and distant recurrence following resection of periampullary cancer. Issue 4 (16th March 2021)

• Record Type: Journal Article
• Authors: Bhandare, M S; Mondal, A; Chaudhari, V; Bal, M; Yadav, S; Ramaswamy, A; Ostwal, V; Shetty, N; Shrikhande, S V
• Is Part Of: British journal of surgery. Volume 108:Issue 4(2021)
• Page Start: 427
• Page End: 434
• Publication Date: 2021-03-16
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znaa143
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences. Methods: This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed. Results: Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM ( P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM. Conclusion: Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery. Abstract : This article analysed 398 patients with periampullary cancers, and identified important prognostic factors associated with local and distant recurrences after curative surgery. The incidence of isolated local recurrence was low, and these patients had significantly better long-term survival than those with distant recurrences. A strategy to prevent development of local recurrences would further add to the survival benefit in these patients.