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A histopathological study of artery wall involvement in pancreatic cancer surgery

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Abstract

Purpose

This study aims to study the depth of artery wall tumour invasion in patients undergoing surgery for pancreatic ductal adenocarcinoma.

Methods

Specimens from 47 pancreatic cancer patients with major arterial (splenic, SA; celiac, CA; common hepatic, CHA) invasion were examined: 45 left (distal) pancreatectomies, including 11 celiac artery resections, and two total pancreatectomies. Dissection of tumour-invaded arteries in 25 fresh specimens was attempted ex vivo using the sub-adventitial dissection technique (SDT). Tumour invasion of 66 arteries was graded using the tumour-free distance (TFD) from the external elastic lamina (EEL): 0 = no arterial invasion; I = TFD ≥ 1 mm; II = TFD < 1 mm; and grade III = EEL invasion.

Results

AJCC TNM staging was IA = 1 (2%), IB = 4 (9%), IIA = 5 (11%), IIB = 17(36%) and III = 20 (43%). Grade III tumour invasion was found in 17/47(36%) SAs, in 5/11 (45%) CAs and in 1/8 (13%) CHAs (p = 0.318). Attempted ex vivo SDT undertaken in 33 arteries from 25 specimens was complete in 16 and incomplete in 17 arteries. The median (IQR) TFD was 0.97 (0.11–2.54) mm in dissected and 0.14 (0.10, 0.14) mm in non-dissected SAs (p = 0.034). EEL tumour invasion occurred in 0/12 (0%) dissected compared to 7/13 (54%) non-dissected SAs (p = 0.005). Grades 0, I, II and III invasion were found in four (33%), two (17%) and six (50%), respectively, of 12 dissected SAs and grades II and III in six 6 (46%) and seven (54%), respectively, of 13 non-dissected SAs (p = 0.002).

Conclusions

The grading system described may form the basis for classification to further develop arterial dissection techniques for pancreatic cancer.

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Funding

This study was supported by grant from the National Natural Science Foundation of China (81672449, 82173206), the Construction Program of Jiangsu Provincial Clinical Research Center Support System (BL2014084), the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Medical Outstanding Talent (to YM, JCRCA2016009) and the Innovation Capability Development Project of Jiangsu Province (No. BM2015004).

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Authors and Affiliations

  1. Pancreas Centre, First Affiliated Hospital, Nanjing Medical University, Nanjing, People’s Republic of China

    Baobao Cai, Zipeng Lu, John P. Neoptolemos, Lingdi Yin, Yong Gao, Kuirong Jiang & Yi Miao

  2. Institut of Pathology, Heidelberg University Hospital, Heidelberg, Germany

    Frank Bergmann

  3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    John P. Neoptolemos & Markus W. Büchler

  4. Pathology Department, First Affiliated Hospital, Nanjing Medical University, Nanjing, People’s Republic of China

    Mingna Li & Cheng Xu

  5. Pancreas Centre, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, People’s Republic of China

    Yi Miao

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  1. Baobao Cai
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Contributions

Baobao Cai, Frank Bergmann and Zipeng Lu drafted the manuscript; Lingdi Yin, Yong Gao and Cheng Xu acquired the data; John P. Neoptolemos, Mingna Li and Kuirong Jiang analysed and interpreted the data; Yi Miao raised the study concept and design; and Yi Miao, Kuirong Jiang and Markus W. Büchler made critical revision of manuscript.

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Correspondence to Yi Miao.

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Cai, B., Bergmann, F., Lu, Z. et al. A histopathological study of artery wall involvement in pancreatic cancer surgery. Langenbecks Arch Surg 407, 3501–3511 (2022). https://doi.org/10.1007/s00423-022-02689-0

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  • DOI: https://doi.org/10.1007/s00423-022-02689-0

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