Recurrence patterns and predictors after pancreaticoduodenectomy for ampullary carcinoma

Recurrence after Whipple for ampullary carcinoma remains incompletely defined; this retrospective cohort aimed to delineate patterns and predictors of failure to guide adjuvant strategies.

Consecutive patients undergoing standard Whipple for histologically proven ampullary adenocarcinoma (January 2018-December 2024) were analyzed (n=189); recurrence patterns were classified, survival estimated by Kaplan-Meier, and predictors assessed by multivariable logistic regression.

Over a median 30.6 months, recurrence occurred in 29.6% (distant 23.3%, local 6.3%); independent predictors of distant recurrence included CA19‑9 >79 U/mL (aOR 2.62; P=0.027), nodal positivity (aOR 2.50; P=0.037), and delayed gastric emptying (aOR 3.17; P=0.006), while adjuvant therapy reduced risk (aOR 0.37; P=0.018). Perineural invasion predicted local recurrence on univariate analysis (OR 8.83; P<0.001); 3‑ and 5‑year overall survival were 69% and 46.1%, respectively, and adjuvant therapy in node‑positive patients reduced distant recurrence from 65.0% to 15.4% (OR 0.098; P<0.001).

Recurrence is predominantly systemic and driven by nodal status and CA19‑9, adjuvant chemotherapy mitigates distant failure-particularly in N1-and the identification of delayed gastric emptying as an independent predictor underscores the oncologic importance of perioperative optimization; histologic subtype was not independently prognostic.