UNLABELLED: In patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC), conversion to total pancreatectomy (TP) may be necessary to achieve R0 resection. HYPOTHESIS: We sought to examine the oncologic benefit of conversion of PD to TP to achieve an R0 resection in patients with an isolated positive neck margin. METHODS: We conducted a retrospective analysis of prospectively collected data at Indiana University and Johns Hopkins Medical Institutions. A review of 1,579 patients who underwent PD or TP for PC at these institutions between 1992 and 2006 was performed. Sixty-one patients were eligible. RESULTS: Twenty-eight patients underwent PD with an isolated positive neck margin found on pathologic examination; 33 patients had conversion to TP for isolated neck margin involvement to achieve R0 resection. Patients undergoing TP versus PD had a greater median survival (18 vs 10 months; P = .04). Mortality (6% vs 7%) and morbidity (36% vs 54%; P = .20) for TP versus PD were comparable. Multivariate analysis revealed PD and greater tumor size as the only independent predictors of poor long-term survival (hazard ratio [HR], 2.2; P = .01 and HR, 1.3; P = .005). CONCLUSIONS: Conversion of PD to TP to achieve an R0 resection in patients with pancreatic adenocarcinoma is associated with a survival benefit.
UNLABELLED: In patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC), conversion to total pancreatectomy (TP) may be necessary to achieve R0 resection. HYPOTHESIS: We sought to examine the oncologic benefit of conversion of PD to TP to achieve an R0 resection in patients with an isolated positive neck margin. METHODS: We conducted a retrospective analysis of prospectively collected data at Indiana University and Johns Hopkins Medical Institutions. A review of 1,579 patients who underwent PD or TP for PC at these institutions between 1992 and 2006 was performed. Sixty-one patients were eligible. RESULTS: Twenty-eight patients underwent PD with an isolated positive neck margin found on pathologic examination; 33 patients had conversion to TP for isolated neck margin involvement to achieve R0 resection. Patients undergoing TP versus PD had a greater median survival (18 vs 10 months; P = .04). Mortality (6% vs 7%) and morbidity (36% vs 54%; P = .20) for TP versus PD were comparable. Multivariate analysis revealed PD and greater tumor size as the only independent predictors of poor long-term survival (hazard ratio [HR], 2.2; P = .01 and HR, 1.3; P = .005). CONCLUSIONS: Conversion of PD to TP to achieve an R0 resection in patients with pancreatic adenocarcinoma is associated with a survival benefit.
Authors: Yakup Kulu; Bruno M Schmied; Jens Werner; Pietro Muselli; Markus W Büchler; Jan Schmidt Journal: HPB (Oxford) Date: 2009-09 Impact factor: 3.647
Authors: Yaojun Zhang; Adam E Frampton; Patrizia Cohen; Charis Kyriakides; Jan J Bong; Nagy A Habib; Duncan R C Spalding; Raida Ahmad; Long R Jiao Journal: J Gastrointest Surg Date: 2012-08-10 Impact factor: 3.452
Authors: Mary Dillhoff; Robert Yates; Kristian Wall; Peter Muscarella; W Scott Melvin; E Christopher Ellison; Mark Bloomston Journal: J Gastrointest Surg Date: 2009-03-10 Impact factor: 3.452