Ryan K Schmocker1, Daniel Delitto2, Michael J Wright2, Ding Ding2, John L Cameron2, Kelly Lafaro2, William R Burns2, Christopher L Wolfgang2, Richard A Burkhart2, Jin He3. 1. Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD; Division of Surgical Oncology, Department of Surgery, The University of Tennessee Graduate School of Medicine. 2. Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD. 3. Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: jhe11@jhmi.edu.
Abstract
BACKGROUND: Historically, a positive margin after pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) was associated with decreased survival. In an era when neoadjuvant chemotherapy (NAC) is being used frequently, the prognostic significance of margin status is unclear. STUDY DESIGN: Patients with localized PDAC who received NAC and underwent pancreatectomy from 2011-2018 were identified from a single-institution database. Patients with fewer than 2 months of NAC, R2 resection, or less than 90-day follow-up were excluded. A positive margin included tumors within 1 mm of the surgical margin. RESULTS: 468 patients met inclusion criteria. The median age was 65 and 53% were female. Preoperative clinical staging demonstrated most had locally advanced (n=222, 47%) or borderline resectable (n=172, 37%) disease. The median follow-up was 18.5 (10.6-30.0) months. The median duration of NAC was 119 (IQR:87-168) days. FOLFIRINOX was first-line therapy for 67%, and 73% received neoadjuvant radiotherapy. Most underwent pancreaticoduodenectomy (69%). 40% were node positive and 80% had an R0 resection. 56% received at least one cycle of adjuvant therapy. Median overall survival (OS) and recurrence-free survival (RFS) were 22.0 (CI: 19.4-25.1) and 11.0 (CI: 10.0-12.1) months. On multivariate analysis, margin status was not a significant predictor of OS or RFS. Factors associated with OS included: clinical stage, duration of NAC, nodal status, histopathologic treatment response score, and receipt of adjuvant chemotherapy. CONCLUSIONS: Microscopic margin positivity is not associated with recurrence and survival in localized PDAC patients resected after treatment with NAC. Aggressive surgical extirpation in high volume centers should be considered in selected patients after extensive NAC.
BACKGROUND: Historically, a positive margin after pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) was associated with decreased survival. In an era when neoadjuvant chemotherapy (NAC) is being used frequently, the prognostic significance of margin status is unclear. STUDY DESIGN:Patients with localized PDAC who received NAC and underwent pancreatectomy from 2011-2018 were identified from a single-institution database. Patients with fewer than 2 months of NAC, R2 resection, or less than 90-day follow-up were excluded. A positive margin included tumors within 1 mm of the surgical margin. RESULTS: 468 patients met inclusion criteria. The median age was 65 and 53% were female. Preoperative clinical staging demonstrated most had locally advanced (n=222, 47%) or borderline resectable (n=172, 37%) disease. The median follow-up was 18.5 (10.6-30.0) months. The median duration of NAC was 119 (IQR:87-168) days. FOLFIRINOX was first-line therapy for 67%, and 73% received neoadjuvant radiotherapy. Most underwent pancreaticoduodenectomy (69%). 40% were node positive and 80% had an R0 resection. 56% received at least one cycle of adjuvant therapy. Median overall survival (OS) and recurrence-free survival (RFS) were 22.0 (CI: 19.4-25.1) and 11.0 (CI: 10.0-12.1) months. On multivariate analysis, margin status was not a significant predictor of OS or RFS. Factors associated with OS included: clinical stage, duration of NAC, nodal status, histopathologic treatment response score, and receipt of adjuvant chemotherapy. CONCLUSIONS: Microscopic margin positivity is not associated with recurrence and survival in localized PDAC patients resected after treatment with NAC. Aggressive surgical extirpation in high volume centers should be considered in selected patients after extensive NAC.
Authors: Martijn A van Dam; Floris A Vuijk; Judith A Stibbe; Ruben D Houvast; Saskia A C Luelmo; Stijn Crobach; Shirin Shahbazi Feshtali; Lioe-Fee de Geus-Oei; Bert A Bonsing; Cornelis F M Sier; Peter J K Kuppen; Rutger-Jan Swijnenburg; Albert D Windhorst; Jacobus Burggraaf; Alexander L Vahrmeijer; J Sven D Mieog Journal: Cancers (Basel) Date: 2021-12-02 Impact factor: 6.639
Authors: Roberto Alva-Ruiz; Lavanya Yohanathan; Jennifer A Yonkus; Amro M Abdelrahman; Lindsey A Gregory; Thorvadur R Halfdanarson; Amit Mahipal; Robert R McWilliams; Wen Wee Ma; Christopher L Hallemeier; Rondell P Graham; Travis E Grotz; Rory L Smoot; Sean P Cleary; David M Nagorney; Michael L Kendrick; Mark J Truty Journal: Ann Surg Oncol Date: 2021-11-01 Impact factor: 5.344