Pancreatic cancer surgery: The new R-status counts

Strobel, Oliver; Hank, Thomas; Hinz, Ulf; Bergmann, Frank; Schneider, Lutz; Springfeld, Christoph; Jäger, Dirk; Schirmacher, Peter; Hackert, Thilo; Büchler, Markus W.

doi:10.1016/j.pan.2016.05.254

Cited by 82 publications

(145 citation statements)

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“…The favourable survival is in line with several other recent studies reporting progress in outcomes after upfront resection and adjuvant therapy. In the authors' previous study of pancreatoduodenectomies, the median survival time and 5‐year survival rate for R0 resections (tumour‐free margin of at least 1 mm) were 41·6 months and 37·7 per cent respectively. Another large institutional series recently reported a median survival of 41·2 months after R0 pancreatoduodenectomies.…”

Section: Discussionmentioning

confidence: 95%

“…Pathological evaluation of the resection specimen followed a standard protocol that was introduced into clinical routine in 2005. Transection and circumferential margins were assessed depending on the tumour location and the type of resection performed.…”

Section: Methodsmentioning

confidence: 99%

“…Circumferential soft tissue margins were analysed depending on the tumour location. The pancreatic head was assessed as described previously.…”

Section: Methodsmentioning

confidence: 99%

“…In a large study of patients undergoing upfront pancreatoduodenectomy for pancreatic head cancer with adjuvant chemotherapy, a 1‐mm tumour‐free margin was an independent predictor of survival. However, the surgical anatomy and resulting surgical margins are different in resections for cancers located in the pancreatic body and tail.…”

Section: Introductionmentioning

confidence: 99%

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Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail

Hank

Hinz

Tarantino

et al. 2018

British Journal of Surgery

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

“…Circumferential soft tissue margins were analysed depending on the tumour location. The pancreatic head was assessed as described previously.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail

Hank

Hinz

Tarantino

et al. 2018

British Journal of Surgery

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“…Standardization of protocol for pathological examination has lead to increased reported positive resection margins rates after pancreaticoduodenectomies (PD) for PDAC: 71% -84.6% (29)(30)(31)(32)(33)(34).…”

Section: What Are the Recurrence Rates And Resection Margins Status Amentioning

confidence: 99%

What is the Value of Total Mesopancreas Excision in Pancreatic Ductal Adenocarcinoma? Current Evidence of the Literature

Popescu¹,

Dumitraşcu²

2018

chr

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Pancreatic ductal adenocarcinoma (PDAC) is a disease with a grim prognosis. Pancreatectomy represents the single hope for long-term survival in a patient with PDAC. Recurrence is a common event after curative-intent surgery for PDAC, mainly related to incomplete removal at the site of resection margins; medial/ superior mesenteric margins are the most often positive. The concept of total mesopancreas excision (TMpE) in PDAC was proposed in analogy to the concept of total mesorectal excision for rectal cancer, to better control loco-regional recurrence. This paper aims to discuss the current evidence for the value of TMpE in PDAC.

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Survival After Minimally Invasive vs Open Surgery for Pancreatic Adenocarcinoma

et al. 2022

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ImportanceOnly a few high-volume centers have reported on long-term oncologic outcomes after minimally invasive pancreatic surgery (MIPS) for pancreatic adenocarcinoma, but none of them have shown superior long-term overall survival (OS) compared with open pancreatic surgery (OPS).ObjectiveTo study long-term survival after MIPS and OPS with curative intent among patients with pancreatic adenocarcinoma.Design, Setting, and ParticipantsThis comparative effectiveness study used a retrospective analysis of a prospectively maintained electronic database of patient data collected between January 2010 and December 2019. Consecutive patients from a high-volume pancreatic cancer referral center were included. Data analysis was conducted from March to October 2022. Median follow-up time was 56.8 months.ExposuresPatients were matched using propensity score models to study long-term survival.Main Outcomes and MeasuresSurvival outcomes were analyzed using the Cox proportional hazards model. Variables used for propensity score correction were TNM stage, tumor dimension, lymph node status, type of operation, simultaneous vascular resection, neoadjuvant chemotherapy, adjuvant chemotherapy, sex, age, and American Society of Anesthesiologists score. Additional corrections were made for year of surgery and type of adjuvant chemotherapy.ResultsAfter propensity score matching the sample of 396 patients, there were 198 patients in the MIPS group (89 [44.9%] men; median [range] age, 68 [32-87] years) and 198 in the OPS group (94 [47.5%] men; median [range] age, 67 [39-84] years). Median OS in the MIPS group was 30.7 (95% CI, 26.2-36.8) months compared with 20.3 (95% CI, 17.6-23.5) months after OPS (hazard ratio [HR], 0.70; 95% CI, 0.56-0.87; P = .002). Median disease-free survival (DFS) after MIPS vs OPS was 14.8 (95% CI, 11.8-17.0) months vs 10.7 (95% CI, 9.0-12.1) months (HR, 0.71; 95% CI, 0.57-0.89; P = .003). Additional corrections for year of surgery and type of adjuvant chemotherapy showed better OS (year of surgery: HR, 0.74; 95% CI, 0.57-0.96; P = .02; adjuvant chemotherapy: HR, 0.71; 95% CI, 0.56-0.90; P = .005) and DFS (year of surgery: HR, 0.77; 95% CI, 0.59-0.99; P = .04; adjuvant chemotherapy: HR, 0.72; 95% CI, 0.57-0.92; P = .009) for patients undergoing minimally invasive vs open surgery.Conclusions and RelevanceIn this study of 396 patients with borderline resectable and resectable pancreatic adenocarcinoma, MIPS was associated with better OS and DFS than OPS. Centralization of MIPS should be stimulated, and pancreatic surgeons should be encouraged to pass the learning curve before implementing MIPS for pancreatic adenocarcinoma in daily clinical practice.

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Pancreatic cancer surgery: The new R-status counts

Cited by 82 publications

References 0 publications

Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail

Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail

What is the Value of Total Mesopancreas Excision in Pancreatic Ductal Adenocarcinoma? Current Evidence of the Literature

Survival After Minimally Invasive vs Open Surgery for Pancreatic Adenocarcinoma

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