Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-06

AUTHORS

Stijn van Roessel, Gyulnara G. Kasumova, Omidreza Tabatabaie, Sing Chau Ng, L. Bengt van Rijssen, Joanne Verheij, Robert M. Najarian, Thomas M. van Gulik, Marc G. Besselink, Olivier R. Busch, Jennifer F. Tseng

ABSTRACT

BACKGROUND: The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival. METHODS: Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan-Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved. RESULTS: Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, < 1, and ≥1 mm, respectively (all log-rank p < 0.001). On multivariate analysis, patients with a margin clearance of ≥1 mm demonstrated a survival advantage relative to those with 0 mm clearance [hazard ratio (HR) 0.71, p < 0.01], whereas survival was comparable for patients with a margin clearance of < 1 mm versus 0 mm (HR: 0.93, p = 0.60). Patients with involvement (0 or < 1 mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7 months) relative to those with SMA involvement (17.5 months). CONCLUSIONS: In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of ≥1 mm correlates with improved survival relative to < 1 mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival. More... »

PAGES

1760-1767

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-018-6467-9

DOI

http://dx.doi.org/10.1245/s10434-018-6467-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1103239334

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29651577


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    "description": "BACKGROUND: The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival.\nMETHODS: Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan-Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved.\nRESULTS: Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1\u00a0months, and the median overall survival was 17.4, 22.9, and 27.7\u00a0months for margin clearances of 0,\u2009<\u20091, and \u22651\u2009mm, respectively (all log-rank p\u2009<\u20090.001). On multivariate analysis, patients with a margin clearance\u00a0of \u22651\u2009mm demonstrated a survival advantage relative to those with 0\u00a0mm clearance [hazard ratio (HR) 0.71, p\u2009<\u20090.01], whereas survival was comparable for patients with a margin clearance\u00a0of\u2009<\u20091\u00a0mm versus 0\u00a0mm (HR: 0.93, p\u2009=\u20090.60). Patients with involvement (0 or\u2009<\u00a01\u00a0mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7\u00a0months) relative to those with SMA involvement (17.5\u00a0months).\nCONCLUSIONS: In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of \u22651\u00a0mm correlates with improved survival relative to\u2009<\u20091\u00a0mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival.", 
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