BACKGROUND: Resection margin status has been shown to impact outcomes for pancreatic adenocarcinoma (PAC), yet it remains unknown whether margin status is a reflection of tumor biology or surgical technique. METHODS: Two hundred eighty-three consecutive patients with pancreatic adenocarcinoma were identified in a prospectively maintained database. Only patients with R0 (n = 207) or R1 (n = 76) tumors were included. Each operative surgeon's first 50 cases were excluded to control for technical inexperience. Univariable and multivariable analyses of clinicopathologic and intra-operative factors were performed. RESULTS: The median follow-up for the cohort was 30.3 months with a median overall survival (OS) of 19.0 months. The R1 group had a higher rate of lymph node ratio >0.2 (41% vs. 25%; P = 0.013), and more microvascular invasion (64% vs. 44%; P = 0.007). R0 resections had both improved overall survival (22.7 months vs. 15.0 months, P = 0.004) and disease free survival (13.5 months vs. 10.7 months, P = 0.026). Factors independently associated with overall survival were microvascular invasion (HR 2.26; P = 0.001), pre-existing pulmonary disease (HR 2.18, P = 0.043), and cardiac disease (HR 1.78, P = 0.033). CONCLUSION: Factors associated with an R1 resection reflect a biologically more aggressive tumor, with a higher likelihood of microvascular invasion and increased positive lymph node ratio.
BACKGROUND: Resection margin status has been shown to impact outcomes for pancreatic adenocarcinoma (PAC), yet it remains unknown whether margin status is a reflection of tumor biology or surgical technique. METHODS: Two hundred eighty-three consecutive patients with pancreatic adenocarcinoma were identified in a prospectively maintained database. Only patients with R0 (n = 207) or R1 (n = 76) tumors were included. Each operative surgeon's first 50 cases were excluded to control for technical inexperience. Univariable and multivariable analyses of clinicopathologic and intra-operative factors were performed. RESULTS: The median follow-up for the cohort was 30.3 months with a median overall survival (OS) of 19.0 months. The R1 group had a higher rate of lymph node ratio >0.2 (41% vs. 25%; P = 0.013), and more microvascular invasion (64% vs. 44%; P = 0.007). R0 resections had both improved overall survival (22.7 months vs. 15.0 months, P = 0.004) and disease free survival (13.5 months vs. 10.7 months, P = 0.026). Factors independently associated with overall survival were microvascular invasion (HR 2.26; P = 0.001), pre-existing pulmonary disease (HR 2.18, P = 0.043), and cardiac disease (HR 1.78, P = 0.033). CONCLUSION: Factors associated with an R1 resection reflect a biologically more aggressive tumor, with a higher likelihood of microvascular invasion and increased positive lymph node ratio.
Authors: Asmita Chopra; Mazen Zenati; Melissa E Hogg; Herbert J Zeh; David L Bartlett; Nathan Bahary; Amer H Zureikat; Joal D Beane Journal: Ann Surg Oncol Date: 2021-05-23 Impact factor: 5.344
Authors: James R Butler; Syed A Ahmad; Matthew H Katz; Jessica L Cioffi; Nicholas J Zyromski Journal: HPB (Oxford) Date: 2016-02-01 Impact factor: 3.647
Authors: Lily Yang; Hari Krishna Sajja; Zehong Cao; Weiping Qian; Laura Bender; Adam I Marcus; Malgorzata Lipowska; William C Wood; Y Andrew Wang Journal: Theranostics Date: 2013-12-17 Impact factor: 11.556
Authors: Ulrich F Wellner; Tobias Krauss; Agnes Csanadi; Hryhoriy Lapshyn; Louisa Bolm; Sylvia Timme; Birte Kulemann; Jens Hoeppner; Simon Kuesters; Gabriel Seifert; Dirk Bausch; Oliver Schilling; Yogesh K Vashist; Thomas Bruckner; Mathias Langer; Frank Makowiec; Ulrich T Hopt; Martin Werner; Tobias Keck; Peter Bronsert Journal: Medicine (Baltimore) Date: 2016-01 Impact factor: 1.817