Impact of Tumor Localization on Early Recurrence After Curative Resection in Pancreatic Ductal Adenocarcinoma.

Background and objectives: Early recurrence (ER) following curative-intent surgery for pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. Identifying preoperative risk factors for ER is essential for optimizing perioperative strategies. This study aimed to investigate perioperative predictors of ER, with a specific focus on tumor localization. Methods: We retrospectively analyzed 163 patients who underwent R0 or R1 resection for PDAC. ER was defined as recurrence within 6 months postoperatively. Two separate multivariate logistic regression analyses were conducted: one including only preoperative variables, and one including both pre- and postoperative factors. Results: ER occurred in 35.6% of patients and was associated with significantly worse overall survival (median 9 vs. 21 months, p < 0.001) and post-recurrence survival (5 vs. 8 months, p = 0.008). Preoperative ECOG performance status > 0 (OR 3.31, p = 0.013) and CA 19-9 > 208 U/mL (OR 3.18, p = 0.022) were identified as independent predictors of ER. In the postoperative model, tumor localization in the body/tail (OR 3.23, p = 0.035), tumor size > 3.25 cm, lymph node ratio > 0.13, and absence of adjuvant therapy were also significant. Notably, tumor location did not influence overall survival. Conclusions: Tumor localization in the body/tail of the pancreas is independently associated with early recurrence but not overall survival. These findings highlight the importance of incorporating tumor site into preoperative risk stratification and support the consideration of neoadjuvant therapy in select anatomically resectable patients, particularly those with left-sided tumors.