Recurrence Timing and Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Retrospective Cohort Study

Background and objectiveRecurrence after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) remains frequent; its timing and anatomical distribution depend on ascertainment and follow-up.The objective of this study was to characterize documented recurrence, recurrence-free survival (RFS), and post-recurrence survival (PRS) in a histopathologically confirmed PDAC cohort. MethodsWe retrospectively screened 141 operations at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, from April 10, 2019, to March 1, 2025, with available follow-up reviewed through October 31, 2026.After excluding 32 neuroendocrine tumors and 13 other non-PDAC primary tumors, 96 patients were included.Early recurrence was defined as occurring within 12 months.RFS included recurrence or allcause death; PRS was compared using the log-rank test. ResultsRecurrence was documented in 39/96 (40.6%) patients; 19 cases occurred within 12 months, and 20 occurred later.All 39 patients had a coded anatomical description of the first recurrence, including synchronous multisite disease.Kaplan-Meier RFS was 77.2% at 12 months, 67.3% at 24 months, and 51.2% at 36 months.The difference in PRS between the early-and late-recurrence groups was not statistically significant (logrank p = 0.494). ConclusionsDocumented recurrence affected approximately two-fifths of patients with confirmed PDAC.The estimated recurrence burden may be affected by loss to follow-up and variations in surveillance; differences in PRS based on recurrence timing were not established.