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.

中文翻译：

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壶腹周围癌切除后影响局部和远处复发的因素。

背景技术胰十二指肠切除术后壶腹周围癌复发是很常见的。这项研究的目的是调查复发，发病率和与局部和远处复发相关的因素的模式。方法这项回顾性单中心研究纳入了2012年1月至2018年1月行根治性切除术的连续壶腹癌患者，分析了其生存率，复发方式以及与复发相关的因素。结果398名患者的中位总体生存期（OS）和无病生存期分别为58.4和49.5个月。23例患者（5.8％）发生孤立的局部复发（LR），50例（12.6％）发生了LR并伴有远处转移（DM），103例（25.9％）发生了孤立的DM。操作系统的中位数是40。孤立性LR患者为4个月，而DM患者为23个月（P <0.001）。肿瘤亚型（远端胆总管（CBD）：比值比（OR）为6.18，95％ci为2.19至17.46）和淋巴结阳性状态（OR为2.36，1.26至4.43）与较高的LR率独立相关。孤立的LR最常见的部位是沿肠系膜上动脉（23名患者中的12名）。DM与肿瘤亚型（远端CBD：OR 2.86，1.09至7.52），淋巴结阳性（OR 2.46，1.53至3.94）和神经周围浸润（OR 1.80，1.02至3.18）相关。结论分离的LR比DM具有更好的生存率，且最常见于肠系膜上动脉。95％的CI（2.19至17.46）和结节阳性状态（OR 2.36，1.26至4.43）与较高的LR率独立相关。孤立的LR最常见的部位是沿肠系膜上动脉（23名患者中的12名）。DM与肿瘤亚型（远端CBD：OR 2.86，1.09至7.52），淋巴结阳性（OR 2.46，1.53至3.94）和神经周围浸润（OR 1.80，1.02至3.18）相关。结论分离的LR比DM具有更好的生存率，且最常见于肠系膜上动脉。95％的CI（2.19至17.46）和结节阳性状态（OR 2.36，1.26至4.43）与较高的LR率独立相关。孤立的LR最常见的部位是沿肠系膜上动脉（23名患者中的12名）。DM与肿瘤亚型（远端CBD：OR 2.86，1.09至7.52），淋巴结阳性（OR 2.46，1.53至3.94）和神经周围浸润（OR 1.80，1.02至3.18）相关。结论分离的LR比DM具有更好的生存率，且最常见于肠系膜上动脉。46、1.53至3.94）和神经周围浸润（OR 1.80、1.02至3.18）与DM独立相关。结论分离的LR比DM具有更好的生存率，且最常见于肠系膜上动脉。46、1.53至3.94）和神经周围浸润（OR 1.80、1.02至3.18）与DM独立相关。结论分离的LR比DM具有更好的生存率，且最常见于肠系膜上动脉。