Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma
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Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated.
Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed.
For PDAC, the R1 rate was 57.1 % (48/84) for any margin, 31.0 % (26/84) for anterior surface, 42.9 % (36/84) for posterior surface, 29.8 % (25/84) for medial margin, and 7.1 % (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17.2 vs. 28.7 months, P = 0.007 and 12.3 vs. 21.0 months, P = 0.019, respectively). For individual margins, only medial positivity had a significant impact on survival (13.8 vs. 28.0 months, P < 0.001), as opposed to involvement in the anterior (19.7 vs. 23.3 months, P = 0.187) or posterior margin (17.5 vs. 24.2 months, P = 0.104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0.002, HR = 0.381; 95 % CI 0.207–0.701).
The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.
KeywordsPancreatic ductal adenocarcinoma Pancreaticoduodenectomy Medial resection margin Prognostic factors Survival
- 6.Pancreatic Section BSoG (2005) Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 54 Suppl 5: v1-16.Google Scholar
- 9.Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, et al. (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 10: 1199-1210; discussion 1210-1191.Google Scholar
- 11.Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, et al. (2004) Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 139: 718-725; discussion 725-717.Google Scholar
- 15.Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, et al. (1995) Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 221: 721-731; discussion 731-723.Google Scholar
- 19.(2003) Japanese Pancreatic Society: Classification of Pancreatic Cancer. Tokyo: Kanahara Publishing Co.Google Scholar
- 20.Hruban RH, Pitman MB, Klimstra DS (2007) Tumors of the pancreas. Atlas of tumor pathology. Washington DC: Armed Forces Institute of Pathology.Google Scholar
- 22.Schmidt CM, Glant J, Winter JM, Kennard J, Dixon J, et al. (2007) Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma. Surgery 142: 572-578; discussion 578-580.Google Scholar
- 24.Williamson R (1994) The pancreas. In: Keen G, Farndon J, editors. Operative surgery and management. Oxford, England: Butterworth Heinemann.Google Scholar
- 26.Pathologists TRCo (2010) Standards and Minimum Datasets for Reporting Cancers. Minimum Dataset for the Histopathological Reporting of Pancreatic, Ampulla of Vater and Bile Duct Carcinoma. London, UK.Google Scholar
- 29.Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, et al. (2010) American Joint Committee on Cancer (AJCC) cancer staging manual. Chicago: Springer.Google Scholar
- 30.Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, et al. (2006) A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 10: 1338-1345; discussion 1345-1336.Google Scholar