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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2025; 17(12): 114403
Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.114403
Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.114403
Very early recurrence after pancreatic cancer resection: Unmasking the "biological R2" enigma and rethinking prognostic paradigms
Peng Wan, Shi-Qiong Zhou, Qing-Hua Ke, Department of Chemoradiotherapy, Jingzhou No. 1 People's Hospital and First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei Province, China
Co-first authors: Peng Wan and Shi-Qiong Zhou.
Author contributions: Ke QH wrote the first draft, developed the main ideas, and led revisions; Wan P and Zhou SQ provided critical feedback, improved the structure, and added key examples. Wan P and Zhou SQ contributed equally to this manuscript as co-first authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Qing-Hua Ke, MD, PhD, Chief Physician, Department of Chemoradio
Received: September 18, 2025
Revised: October 4, 2025
Accepted: October 29, 2025
Published online: December 27, 2025
Processing time: 98 Days and 11.3 Hours
Revised: October 4, 2025
Accepted: October 29, 2025
Published online: December 27, 2025
Processing time: 98 Days and 11.3 Hours
Core Tip
Core Tip: Very early recurrence (VER) in pancreatic ductal adenocarcinoma (PDAC), a "biological R2 resection," occurs when macroscopically complete surgery fails to stop aggressive tumor progression. Martlı et al’s study of 303 PDAC patients identified G3 tumors (strongest predictor), pancreatic head location (contrary to prior assumptions), and elevated red cell distribution width as VER predictors, with VER doubling the 6-month mortality rate. These findings urge a shift to risk-stratified PDAC management, but the study’s retrospective, single-center design and lack of molecular data limit conclusions. Future research should validate predictors, test risk-stratified strategies, and explore VER’s molecular drivers.