Prognostic Impact of Resection Margin Status in Distal Pancreatectomy for Ductal Adenocarcinoma.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
24
03
2021
accepted:
29
06
2021
pubmed:
24
7
2021
medline:
22
12
2021
entrez:
23
7
2021
Statut:
ppublish
Résumé
Resection margin status is considered one of the few surgeon-controlled parameters affecting prognosis in pancreatic ductal adenocarcinoma (PDAC). While studies mostly focus on resection margins in pancreatoduodenectomy, little is known about their role in distal pancreatectomy (DP). This study aimed to investigate resection margins in DP for PDAC. Patients who underwent DP for PDAC between October 2004 and February 2020 were included (n = 124). Resection margins and associated parameters were studied in two consecutive time periods during which different pathology examination protocols were used: non-standardized (period 1: 2004-2014) and standardized (period 2: 2015-2020). Microscopic margin involvement (R1) was defined as ≤1 mm clearance. Laparoscopic and open resections were performed in 117 (94.4%) and 7 (5.6%) patients, respectively. The R1 rate for the entire cohort was 73.4%, increasing from 60.4% in period 1 to 83.1% in period 2 (p = 0.005). A significantly higher R1 rate was observed for the posterior margin (35.8 vs. 70.4%, p < 0.001) and anterior pancreatic surface (based on a 0 mm clearance; 18.9 vs. 35.4%, p = 0.045). Pathology examination period, poorly differentiated PDAC, and vascular invasion were associated with R1 in the multivariable model. Extended DP, positive anterior pancreatic surface, lymph node ratio, perineural invasion, and adjuvant chemotherapy, but not R1, were significant prognostic factors for overall survival in the entire cohort. Pathology examination is a key determinant of resection margin status following DP for PDAC. A high R1 rate is to be expected when pathology examination is meticulous and standardized. Involvement of the anterior pancreatic surface affects prognosis.
Sections du résumé
BACKGROUND
BACKGROUND
Resection margin status is considered one of the few surgeon-controlled parameters affecting prognosis in pancreatic ductal adenocarcinoma (PDAC). While studies mostly focus on resection margins in pancreatoduodenectomy, little is known about their role in distal pancreatectomy (DP). This study aimed to investigate resection margins in DP for PDAC.
METHODS
METHODS
Patients who underwent DP for PDAC between October 2004 and February 2020 were included (n = 124). Resection margins and associated parameters were studied in two consecutive time periods during which different pathology examination protocols were used: non-standardized (period 1: 2004-2014) and standardized (period 2: 2015-2020). Microscopic margin involvement (R1) was defined as ≤1 mm clearance.
RESULTS
RESULTS
Laparoscopic and open resections were performed in 117 (94.4%) and 7 (5.6%) patients, respectively. The R1 rate for the entire cohort was 73.4%, increasing from 60.4% in period 1 to 83.1% in period 2 (p = 0.005). A significantly higher R1 rate was observed for the posterior margin (35.8 vs. 70.4%, p < 0.001) and anterior pancreatic surface (based on a 0 mm clearance; 18.9 vs. 35.4%, p = 0.045). Pathology examination period, poorly differentiated PDAC, and vascular invasion were associated with R1 in the multivariable model. Extended DP, positive anterior pancreatic surface, lymph node ratio, perineural invasion, and adjuvant chemotherapy, but not R1, were significant prognostic factors for overall survival in the entire cohort.
CONCLUSIONS
CONCLUSIONS
Pathology examination is a key determinant of resection margin status following DP for PDAC. A high R1 rate is to be expected when pathology examination is meticulous and standardized. Involvement of the anterior pancreatic surface affects prognosis.
Identifiants
pubmed: 34296358
doi: 10.1245/s10434-021-10464-6
pii: 10.1245/s10434-021-10464-6
pmc: PMC8677636
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
366-375Informations de copyright
© 2021. The Author(s).
Références
J Vis Exp. 2020 Feb 1;(156):
pubmed: 32065168
Histopathology. 2008 Jun;52(7):787-96
pubmed: 18081813
Ann Surg Oncol. 2021 Feb;28(2):1079-1087
pubmed: 32583198
Br J Surg. 2015 Nov;102(12):1459-72
pubmed: 26350029
Ann Surg Oncol. 2016 Feb;23(2):585-91
pubmed: 26508153
J Natl Compr Canc Netw. 2019 Mar 1;17(3):202-210
pubmed: 30865919
PLoS One. 2016 Sep 16;11(9):e0163266
pubmed: 27636547
Surgery. 2007 Jul;142(1):20-5
pubmed: 17629996
Br J Surg. 2006 Oct;93(10):1232-7
pubmed: 16804874
Ann Surg. 2015 Nov;262(5):868-73; discussion 873-4
pubmed: 26583678
J Gastrointest Surg. 2006 Dec;10(10):1338-45; discussion 1345-6
pubmed: 17175452
Ann Surg Oncol. 2008 Jun;15(6):1651-60
pubmed: 18351300
Updates Surg. 2020 Jun;72(2):387-397
pubmed: 32266660
Surgery. 2014 Jul;156(1):1-14
pubmed: 24856668
HPB (Oxford). 2016 Jan;18(1):21-8
pubmed: 26776847
Histopathology. 2020 Jan;76(2):182-188
pubmed: 31433515
Langenbecks Arch Surg. 2018 Dec;403(8):941-948
pubmed: 30417281
Surg Endosc. 2016 Aug;30(8):3409-18
pubmed: 26514135
J Gastrointest Surg. 2017 Oct;21(10):1620-1625
pubmed: 28766272
Surgery. 2017 Oct;162(4):802-811
pubmed: 28756944
Histopathology. 2009 Sep;55(3):277-83
pubmed: 19723142
World J Surg. 2015 Feb;39(2):493-9
pubmed: 25270344
Ann Surg. 2009 Aug;250(2):177-86
pubmed: 19638919
Surgery. 2017 Mar;161(3):584-591
pubmed: 28040257
J Hepatobiliary Pancreat Surg. 2004;11(6):402-8
pubmed: 15619016
Surgery. 2015 Jun;157(6):1106-12
pubmed: 25704430
HPB (Oxford). 2009 Feb;11(1):18-24
pubmed: 19590619
HPB (Oxford). 2018 Feb;20(2):175-181
pubmed: 28943397
Surgery. 2012 May;151(5):717-23
pubmed: 22284762
J Clin Oncol. 2009 Jun 10;27(17):2855-62
pubmed: 19398572
Eur J Surg Oncol. 2013 Jun;39(6):559-66
pubmed: 23498362
Ann Surg. 2013 Apr;257(4):731-6
pubmed: 22968073
Ann Surg Oncol. 2017 Nov;24(12):3674-3682
pubmed: 28871564
Surg Endosc. 2018 Jan;32(1):53-61
pubmed: 28643065
Ann Surg. 2019 Dec;270(6):1138-1146
pubmed: 29672406
Ann Surg Oncol. 2021 Aug;28(8):4602-4612
pubmed: 33393031
Ann Surg. 2018 Dec;268(6):1058-1068
pubmed: 28692477
Int J Surg. 2014 Dec;12(12):1495-9
pubmed: 25046131