Martlı HF, İnsan HO, Altaş M, Erişmiş B, Çayhan V, Ersoy O, Keşkek M, Tez M. Clinicopathological features of patients undergoing surgery for pancreatic cancer with very early postoperative recurrence. World J Gastrointest Surg 2025; 17(11): 111202 [DOI: 10.4240/wjgs.v17.i11.111202]
Corresponding Author of This Article
Mesut Tez, Department of Surgery, University of Health Sciences, Ankara City Hospital, 1 Bilkent Street, District of Universities, Ankara 06800, Türkiye. mesuttez@yahoo.com
Research Domain of This Article
Oncology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Nov 25, 2025
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Martlı HF, İnsan HO, Altaş M, Erişmiş B, Çayhan V, Ersoy O, Keşkek M, Tez M. Clinicopathological features of patients undergoing surgery for pancreatic cancer with very early postoperative recurrence. World J Gastrointest Surg 2025; 17(11): 111202 [DOI: 10.4240/wjgs.v17.i11.111202]
World J Gastrointest Surg. Nov 27, 2025; 17(11): 111202 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.111202
Clinicopathological features of patients undergoing surgery for pancreatic cancer with very early postoperative recurrence
Hüseyin Fahri Martlı, Hüseyin Oytun İnsan, Mert Altaş, Betül Erişmiş, Velihan Çayhan, Osman Ersoy, Mehmet Keşkek, Mesut Tez
Hüseyin Fahri Martlı, Department of General Surgery, Ankara City Hospital, Ankara 06800, Türkiye
Hüseyin Oytun İnsan, Mert Altaş, Department of Surgery, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Betül Erişmiş, Department of Internal Medicine, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Velihan Çayhan, Department of Radiology, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Osman Ersoy, Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Mehmet Keşkek, Department of General Surgery, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Mesut Tez, Department of Surgery, University of Health Sciences, Ankara City Hospital, Ankara 06800, Türkiye
Author contributions: Martlı HF contributed to the study design, surgical data collection, and manuscript drafting; İnsan HO participated in surgical data collection and analyses; Altaş M assisted in surgical data collection and statistical analyses; Erişmiş B contributed to clinical data collection and patient follow-up; Çayhan V performed radiological assessments and data interpretation; Ersoy O provided gastroenterological expertise and contributed to data interpretation; Keşkek M participated in the study design, surgical procedures, and critical revision of the manuscript; Tez M conceptualized the study, supervised the research, performed data analyses, and wrote and revised the manuscript; All authors reviewed and approved the final manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Research and Scientific Evaluation Committee of Ankara City Hospital (Approval No. TABED 2-24-557). All patient data were anonymized to protect.
Informed consent statement: Informed consent was waived due to the retrospective nature of the study, as approved by the Medical Research and Scientific Evaluation Committee of Ankara City Hospital.
Conflict-of-interest statement: The authors have no conflicts of interest to declare. No financial or personal relationships with individuals or organizations that could inappropriately influence this work were reported.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data supporting the findings of this study are available upon reasonable request from the corresponding author, Mesut Tez (mesuttez@yahoo.com), subject to approval by the Medical Research and Scientific Evaluation Committee of Ankara City Hospital. All data were anonymized to protect patient confidentiality, and access will comply with ethical standards and institutional regulations. Raw data are not publicly available due to privacy restrictions.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mesut Tez, Department of Surgery, University of Health Sciences, Ankara City Hospital, 1 Bilkent Street, District of Universities, Ankara 06800, Türkiye. mesuttez@yahoo.com
Received: June 25, 2025 Revised: July 3, 2025 Accepted: September 15, 2025 Published online: November 27, 2025 Processing time: 153 Days and 16.2 Hours
Abstract
BACKGROUND
Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy, with approximately 50% of patients experiencing recurrence within 1-year post-surgery. Very early recurrence (VER), defined as recurrence within 12 weeks, is an emerging concept.
AIM
To investigate clinicopathological characteristics and predictive factors for VER in patients with PDAC.
METHODS
A retrospective cohort study was conducted on 553 patients who underwent pancreatic surgery for PDAC at a single high-volume center between February 2019 and December 2024. Patients with VER (group 1, n = 28) were compared to those without (group 2, n = 251) after excluding 24 patients with inadequate surgical resection. Clinicopathological characteristics were compared using univariate and multivariate analyses, supplemented by random forest modeling to identify nonlinear patterns (P < 0.05).
RESULTS
Group 1 patients were younger (65 ± 16.85 years vs 68 ± 9.58 years; P < 0.001) and had higher 6-month mortality (32.44% vs 14.77%; P = 0.032). Poorly differentiated tumors (G3) were the strongest predictor of VER (odds ratio = 2.43, 95% confidence interval: 0.88-5.34; P < 0.001, random forest feature importance: 0.35). Pancreatic head tumors (P = 0.031) and elevated red cell distribution width (P = 0.03) were associated with VER in univariate analysis. Sensitivity analysis confirmed imaging timing (4-8 weeks vs 8-12 weeks) did not significantly alter recurrence classification (P = 0.12).
CONCLUSION
Poorly differentiated tumors are a key predictor of VER, linked to higher mortality. Machine learning enhances predictive accuracy, and molecular studies are needed to elucidate VER mechanisms. Tailored surveillance and multi-institutional validation are recommended.
Core Tip: This study investigated very early recurrence (VER), defined as recurrence within 12 weeks post-surgery, in patients with pancreatic ductal adenocarcinoma (PDAC). It identified poorly differentiated tumors as a key predictor of VER, linked to higher 6-month mortality, offering a novel prognostic marker. Unlike prior research, it highlights pancreatic head tumors’ association with VER, challenging body/tail dominance theories. The findings suggest tailored surveillance and molecular studies to improve outcomes, marking a significant step toward personalized PDAC management.
