Background: Survival after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains poor because of high incidences of recurrence. The risk factors, patterns, and long-term prognosis in patients with early recurrence and late recurrence (ER and LR) for PDAC after PD were studied. Methods: Data from patients who underwent PD for PDAC were analyzed. Recurrence was divided into ER (ER ≤1 years) and LR (LR >1 years) using the time to recurrence after surgery. Characteristics and patterns of initial recurrence, and postrecurrence survival (PRS) were compared between patients with ER and LR. Results: Among the 634 patients, 281 (44.3%) and 249 (39.3%) patients developed ER and LR, respectively. In the multivariate analysis, preoperative CA19-9 levels, resection margin status, and tumor differentiation were significantly associated with both ER and LR, while lymph node metastasis and perineal invasion were associated with LR. Patients with ER, when compared with patients with LR, showed a significantly higher proportion of liver-only recurrence (P<0.05), and worse median PRS (5.2 vs. 9.3 months, P<0.001). Lung-only recurrence had a significantly longer PRS when compared with liver-only recurrence (P<0.001). Multivariate analysis demonstrated that ER and irregular postoperative recurrence surveillance were independently associated with a worse prognosis (P<0.001). Conclusion: The risk factors for ER and LR after PD are different for PDAC patients. Patients who developed ER had worse PRS than those who developed LR. Patients with lung-only recurrence had a significantly better prognosis than those with other recurrent sites.

Background: The experience of minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumours (DGISTs) is accumulating, but there is no consensus on the choice of surgical method. The purpose of this study is to summarize the technique and feasibility of robotic resection of DGIST.Methods: The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGIST between May 1, 2010 and May 1, 2020 were retrospectively analysed. Patients were divided into an open surgery group and a robotic surgery group. Pancreaticoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups.Results: Among the 28 patients, there were 19 males and 9 females aged 51.3± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (p>0.05). OT and EBL in the robotic group were significantly different from those in the open surgery group (p<0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (p>0.05).Conclusions: Robotic resection is safe and feasible for patients with duodenal gastrointestinal stromal tumours, and its therapeutic effect is equivalent to open surgery.