ThTP1.10 Whipple's for ampullary adenocarcinoma: can we predict who will develop local only recurrence and tailor treatment to individuals?

Abstract

Abstract Aims Following pancreatoduodenectomy (PD) for ampullary adenocarcinoma (AA), cancer recurrence rates are high. There are currently no models available which can estimate which patients are likely to develop local only recurrence. Using a multicentre cohort, this study aimed to compare patients who developed local only recurrence to those who developed distant (+/- local) recurrence. Methods A retrospective review of patients who underwent PD for AA was carried out (2012-2015). The group that developed local only recurrence was compared to the group that developed distant (+/- local) recurrence (within five years of PD). The following were compared: demographics, preoperative comorbidities/functional status, preoperative imaging and blood tests, postoperative complications and histological details, and adjuvant treatment. Means were compared using Student’s t-test, medians were compared using the Mann Whitney U test and percentages were compared using Fisher’s exact test. Results Of the 394 included patients, 45% developed recurrent AA. Of these, local only recurrence, distant only recurrence, and local and distant recurrence affected 34 (20%), 94 (55%) and 41 (23%) patients, respectively (unknown site of recurrence: 7). When the group that developed local only recurrence (n=34) was compared to the group that developed distant (+/- local) recurrence (n=135), no statistically significant differences were observed. Conclusions In our multicentre study of patients who underwent PD for AA, 9% developed local only recurrence and 34% developed distant (+/-local) recurrence. No significant differences were observed between the two groups. This highlights the difficulties clinicians face when attempting to tailor treatment to individuals.