Impact of resection margin status on recurrence and survival in pancreatic cancer surgery.
Published: 18th March 2019
Authors: W. S. Tummers, J. V. Groen, B. G. Sibinga Mulder, A. Farina‐Sarasqueta, J. Morreau, H. Putter et al.
The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is poor and selection of patients for surgery is challenging. This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics and/or technical factors associated with a positive resection margin in patients with PDAC.
Patients scheduled for pancreatic resection for PDAC between 2006 and 2016 were identified from an institutional database. The effect of resection margin status, patient characteristics and tumour characteristics on LRR, distant metastasis and OS was assessed.
A total of 322 patients underwent pancreatectomy for PDAC. A positive resection (R1) margin was found in 129 patients (40·1 per cent); this was associated with decreased OS compared with that in patients with an R0 margin (median 15 (95 per cent c.i. 13 to 17) versus 22 months; P < 0·001). R1 status was associated with reduced time to LRR (median 16 versus 36 (not estimated, n.e.) months; P = 0·002). Disease recurrence patterns were similar in the R1 and R0 groups. Risk factors for early recurrence were tumour stage, positive lymph nodes (N1) and perineural invasion. Among 100 patients with N0 disease, R1 status was associated with shorter OS compared with R0 resection (median 17 (10 to 24) versus 45 (n.e.) months; P = 0·002), whereas R status was not related to OS in 222 patients with N1 disease (median 14 (12 to 16) versus 17 (15 to 19) months after R1 and R0 resection respectively; P = 0·068).
Although pancreatic resection with a positive margin was associated with poor survival and early recurrence, particularly in patients with N1 disease, disease recurrence patterns were similar between R1 and R0 groups.Full text
You may also be interested in
Clinical value of additional resection of a margin‐positive distal bile duct in perihilar cholangiocarcinoma. BJS 2019; 106: 774-782.
Authors: S. Otsuka, T. Ebata, Y. Yokoyama, T. Mizuno, T. Tsukahara, Y. Shimoyama et al.
Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. BJS 2019; 106: 756-764.
Authors: J. Kirkegård, E. K. Aahlin, M. Al‐Saiddi, S. O. Bratlie, M. Coolsen, R. J. de Haas et al.
Outcomes following pancreatic surgery using three different thromboprophylaxis regimens. BJS 2019; 106: 765-773.
Authors: R. G. Hanna‐Sawires, J. V. Groen, F. A. Klok, R. A. E. M. Tollenaar, W. E. Mesker, R. J. Swijnenburg et al.
Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. BJS 2019; 106: 626-635.
Authors: T. Mizuno, T. Ebata, Y. Yokoyama, T. Igami, J. Yamaguchi, S. Onoe et al.
Systematic review of clinical prediction models for survival after surgery for resectable pancreatic cancer. BJS 2019; 106: 342-354.
Authors: M. Strijker, J. W. Chen, T. H. Mungroop, N. B. Jamieson, C. H. van Eijck, E. W. Steyerberg et al.
Randomized clinical trial
Randomized trial of oral versus enteral feeding for patients with postoperative pancreatic fistula after pancreatoduodenectomy. BJS 2019; 106: 190-198.
Authors: J.‐M. Wu, T.‐C. Kuo, H.‐A. Chen, C.‐H. Wu, S.‐R. Lai, C.‐Y. Yang et al.
Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery. BJS 2019; 106: 616-625.
Authors: Y. Uchida, T. Masui, K. Nakano, A. Yogo, A. Sato, K. Nagai et al.
Multicentre propensity score‐matched study of laparoscopic versus open repeat liver resection for colorectal liver metastases. BJS 2019; 106: 783-789.
Authors: M. J. van der Poel, L. Barkhatov, D. Fuks, G. Berardi, F. Cipriani, A. Aljaiuossi et al.
Authors: T. M. Mackay, U. F. Wellner, L. B. van Rijssen, T. F. Stoop, O. R. Busch, B. Groot Koerkamp et al.
Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth. BJS 2019; 106: 427-435.
Authors: K. Shinohara, T. Ebata, Y. Shimoyama, M. Nakaguro, T. Mizuno, K. Matsuo et al.
Systematic review of management of incidental gallbladder cancer after cholecystectomy. BJS 2019; 106: 32-45.
Authors: K. Søreide, R. V. Guest, E. M. Harrison, T. J. Kendall, O. J. Garden, S. J. Wigmore et al.
Systematic review of the quantity and quality of randomized clinical trials in pancreatic surgery. BJS 2019; 106: 23-31.
Authors: F. J. Hüttner, L. Capdeville, F. Pianka, A. Ulrich, T. Hackert, M. W. Büchler et al.