Intensified Histopathological Work-Up after Pancreatic Head Resection Reveals Relevant Prognostic Markers

Abstract

Introduction: Local recurrence remains a major problem after pancreatic head resection. Intensified histopathological work-up of surgical specimens after pancreatic head resection has revealed an increased number of incomplete resections (R1) depending on tumor infiltration front at the resection margins (RMs). It remains unclear to which extent the increased R1 resection rate has a clinical relevance for the patients’ prognosis. Materials and Methods: Pancreatic head resections between 2006 and 2012 were histologically intensively worked-up by a previously described protocol. The distance between the tumor infiltration front and the resection planes or organ surfaces was documented. The impact of the size of the tumor and an additional portal vein resection was analyzed. The effect of a R1 resection status on development and type of recurrence was evaluated. Results: A total of 203 pancreatic head resections were evaluated. Different definitions of R1 resection were applied. These led to significantly different prognosis for patients. A greater distance between the tumor infiltration front and the resection plane or organ surface was associated with a better outcome for the patients. For the ventral surface, the mesopancreas and the pancreatic body these differences were statistically significant comparing the different R1 definitions. For the dorsal surface, a significant difference in prognosis was found if the tumor was >2 mm away from the resection surface. A tumor size of 3 cm was identified to play a relevant role for the prognosis. Patients who had a portal vein resection without a histologically proven infiltration showed a statistically significant higher overall survival. Patients with R1 resection were at highest risk for developing local recurrence as well as distant metastasis. Conclusion: Intensified histopathological work-up with an increased number of R1 resections has a clinical relevance for patients’ prognosis. Tumors with a smaller size or with a greater distance to the organ surface or RM have a better outcome.

Impact of Portal Vein Resection (PVR) in Patients Who Underwent Curative Intended Pancreatic Head Resection

“…CT scans during follow-up were either part of the surveillance or they became necessary if recurrence was suspected. The surgical procedure was performed as previously described [12]. Portal vein resection was performed by either local excision and primary suture or circular resection of PV and end-to-end anastomosis.…”

“…Resection of portal vein (PV) or superior mesenteric vein (SMV) became the standard of care in pancreatic surgery if necessary to achieve complete resection (R0). In contrast to arterial resections, vein resections can be safely performed without an increase in morbidity 2 of 12 or mortality [1,2]. Over the past years, the oncological role of PV/SMV resection was discussed.…”

“…In a previous analysis [12], we evaluated patients with pancreatic head cancer and a rigid histopathological work-up. With respect to histopathological confirmed infiltration of the PV, no statistically significant survival difference was found.…”

Comparative analysis of surgical treatment of patients with locally advanced tumors right anatomical segment of pancreas

“…Негативний край резекції після оперативного лікування хворих на протокову аденокарциному головки підшлункової залози залишається найважливішим фактором, що впливає на загальну виживаність таких пацієнтів [13]. З моменту проведення планового патоморфологічного дослідження в нашому інституті за рекомендаціями College of American Pathologist 2020, що включають оцінку судинних країв резекції ПЗ -встановлено, що найчастіше саме венозний край уражений комплексами протокової аденокарциноми ПЗ, в порівнянні з частотою залучення інших країв резекції.…”