Risk Factors and Vascular Features Associated With Local Recurrence in Pancreatic Cancer Post-Pancreaticoduodenectomy: A Retrospective Cohort Study

Objectives

This study aims to analyze the risk factors for local recurrence (LR) following pancreaticoduodenectomy (PD) in pancreatic cancer patients and to identify vascular features associated with this outcome.

Background

Pancreatic cancer frequently involves the mesenteric root, particularly the Porto-mesenteric vein (PV-SMV), impacting survival post curative surgery. However, the relationship between vascular structural changes and LR post-operation remains unclear.

Methods

Retrospective data collection was conducted at a single tertiary center from December 2010 to March 2021. Clinical characteristics, surgical-pathological factors, and radiological features were compiled.

Results

A total of 203 pancreatic cancer cases undergoing PD were analyzed, with 72 (35.5%) undergoing concurrent PV-SMV resection (VR). Median overall survival post-operation was 22.4 months. LR occurred in 121 patients (60%) at a median time of 8 months postoperatively. Resectable disease exhibited significantly longer local-recurrence free survival compared to borderline resectable/locally advanced pancreatic cancer (BRPC/LAPC) (median 14.5 vs. 7 months, p < 0.001). The most frequent sites of LR were the mesenteric root (37%), superior mesenteric artery (SMA, 21%), and superior mesenteric vein (SMV, 16%), with similar patterns observed in the VR and non-VR groups. BRPC, LAPC, postoperative CA19-9 above normal range, venous thrombosis, and stenosis were associated with LR (HR: 2.1 [95% CI 1.21–3.68], 2.7 [95% CI 1.6–4.71], 1.8 [95% CI 1.21–2.69], 2.0 [95% CI 1.08–3.92], and 1.6 [95% CI 1.0–2.65], respectively), while PV-SMV resection and enlargement of PV-SMV angle were protective factors (HR: 0.4 [95% CI 0.25–0.67] and 0.3 [95% CI 0.19–0.53]).

Conclusions

Despite aggressive treatment strategies including neoadjuvant therapy and radical surgery, LR in pancreatic cancer remains a challenge. This study highlights potential risk factors, recurrence patterns, and associated vascular features for early identification. These findings may guide clinicians in developing more targeted surveillance strategies and inform future research on preventing LR.