{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T15:43:39Z","timestamp":1780587819617,"version":"3.54.1"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:00:00Z","timestamp":1554681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Few studies of the oncological outcomes of ampullary cancer have addressed recurrence, and many treatment\u2010related issues remain unresolved. This study evaluated optimal surgical treatment strategies based on recurrence patterns after pancreaticoduodenectomy (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>) for ampullary cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred and fifty\u2010nine patients who underwent <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> with R0 resection for ampullary cancer from January 2000 to June 2012 were included. Generally, lymph node (<jats:styled-content style=\"fixed-case\">LN<\/jats:styled-content>) dissection extended to the right superior mesenteric artery (<jats:styled-content style=\"fixed-case\">SMA<\/jats:styled-content>). Recurrence was defined based on imaging studies. The first detected recurrence sites and patterns were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a mean follow\u2010up of 51.3\u00a0months, recurrence occurred in 89 (34.4%) cases, most commonly in the liver. Poor differentiation, advanced T stage, and <jats:styled-content style=\"fixed-case\">LN<\/jats:styled-content> metastasis were identified as risk factors for recurrence. Locoregional and systemic recurrences occurred alone or simultaneously in 20.2%, 73.0%, and 6.7% of patients, respectively. Locoregional and systemic recurrences tended to occur in early\u2010 and advanced\u2010stage cases, respectively. A nodal\u2010type recurrence around mesenteric vessels was the most common locoregional recurrence pattern, and 58.8% (10\/17) were located left of the <jats:styled-content style=\"fixed-case\">SMA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>As nodal\u2010type metastasis around the mesenteric vessels was the dominant recurrence pattern, careful <jats:styled-content style=\"fixed-case\">LN<\/jats:styled-content> dissection around the <jats:styled-content style=\"fixed-case\">SMA<\/jats:styled-content> should be considered for early and advanced ampullary cancers.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.618","type":"journal-article","created":{"date-parts":[[2019,3,8]],"date-time":"2019-03-08T21:10:41Z","timestamp":1552079441000},"page":"179-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Recurrence patterns after pancreaticoduodenectomy for ampullary 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