Fabio Ausania1, Santiago Sanchez-Cabus1, Paula Senra Del Rio2, Alex Borin3, Juan Ramon Ayuso4, Pilar Bodenlle5, Sofia Espinoza1, Miriam Cuatrecasas6, Carlos Conill7, Tamara Saurí8, Joana Ferrer1, Josep Fuster1, Juan Carlos García-Valdecasas1, Reyes Melendez2, Constantino Fondevila1. 1. Department of HPB and Transplant Surgery, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. 2. Department of HPB Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. 3. Department of HPB and Transplant Surgery, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. alexborin.ab@gmail.com. 4. Department of Radiology, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain. 5. Department of Radiology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. 6. Department of Pathology, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain. 7. Department of Radiotherapy, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain. 8. Department of Medical Oncology, Hospital Clinic and Department of Medicine, University of Barcelona, Barcelona, Spain.
Abstract
INTRODUCTION: The NCCN classification of resectability in pancreatic head cancer does not consider preoperative radiological tumour ≤ 180° contact with portal vein/superior mesenteric vein (PV/SMV) as a negative prognostic feature. The aim of this study is to evaluate whether this factor is associated with higher rate of incomplete resection and poorer survival. METHODS: All patients considered for pancreatic resection between 2012 and 2017 at two Spanish referral centres were included. Patients with borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC) according to NCCN classification were excluded. Preoperative CT scans were reviewed by dedicated radiologists to identify radiologic tumour contact with PV/SMV. RESULTS: Out of 302, 71 patients were finally included in this study. Twenty-two (31%) patients showed tumour-PV/SMV contact (group 1) and 49 (69%) did not show any contact (group 2). Patients in group 1 showed a statistically significantly higher rate of R1 and R1-direct margins compared with group 2 (95 vs 28% and 77 vs 10%) and lower median survival (24 vs 41 months, p = 0.02). Preoperative contact with PV/SMV, lymph node metastases, R1-direct margin and NO adjuvant chemotherapy were significantly associated with disease-specific survival at multivariate analysis. CONCLUSION: Preoperative radiological tumour contact with PV/SMV in patients with NCCN resectable PDAC is associated with high rate of pathologic positive margins following surgery and poorer survival.
INTRODUCTION: The NCCN classification of resectability in pancreatic head cancer does not consider preoperative radiological tumour ≤ 180° contact with portal vein/superior mesenteric vein (PV/SMV) as a negative prognostic feature. The aim of this study is to evaluate whether this factor is associated with higher rate of incomplete resection and poorer survival. METHODS: All patients considered for pancreatic resection between 2012 and 2017 at two Spanish referral centres were included. Patients with borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC) according to NCCN classification were excluded. Preoperative CT scans were reviewed by dedicated radiologists to identify radiologic tumour contact with PV/SMV. RESULTS: Out of 302, 71 patients were finally included in this study. Twenty-two (31%) patients showed tumour-PV/SMV contact (group 1) and 49 (69%) did not show any contact (group 2). Patients in group 1 showed a statistically significantly higher rate of R1 and R1-direct margins compared with group 2 (95 vs 28% and 77 vs 10%) and lower median survival (24 vs 41 months, p = 0.02). Preoperative contact with PV/SMV, lymph node metastases, R1-direct margin and NO adjuvant chemotherapy were significantly associated with disease-specific survival at multivariate analysis. CONCLUSION: Preoperative radiological tumour contact with PV/SMV in patients with NCCN resectable PDAC is associated with high rate of pathologic positive margins following surgery and poorer survival.
Authors: M Tanaka; A L Mihaljevic; P Probst; M Heckler; U Klaiber; U Heger; M W Büchler; T Hackert Journal: Br J Surg Date: 2019-08-27 Impact factor: 6.939
Authors: Eric P Tamm; Aparna Balachandran; Priya R Bhosale; Matthew H Katz; Jason B Fleming; Jeffrey H Lee; Gauri R Varadhachary Journal: Radiol Clin North Am Date: 2012-04-06 Impact factor: 2.303