Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens

Delpero, Jean Robert; Bachellier, Philippe; Régenet, Nicolas; Treut, Yves Patrice Le; Paye, François; Carrère, Nicolas; Sauvanet, Alain; Autret, A.; Turrini, Olivıer; Monges-Ranchin, Geneviève; Boher, Jean-Marie

doi:10.1111/hpb.12061

Cited by 154 publications

(123 citation statements)

References 59 publications

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“…Furthermore, 2 patients in the present study had multiple MUP(+) sites (22.2%), mainly in Area B, at a rate lower than that described in other reports 9,20 . This result was due to the exclusion of patients with borderline resectable pancreatic cancer 15 and patients with PLsma invasive pancreatic cancer and the execution of en bloc dissection via the left posterior approach for PD 36,38 .…”

Section: Discussioncontrasting

confidence: 74%

Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas

et al. 2017

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Background: Characteristics of a cancer-positive margin around a resected uncinate process of the pancreas (MUP) due to a pancreticoduodenectomy are difficult to understand by standardized evaluation because of its complex anatomy.The purposes of this study were to subclassify the MUP with tissue marking dyes of different colors and to identify the characteristics of sites that showed positivity for cancer cells in patients with pancreatic head carcinoma who underwent circumferential superior mesenteric arterial nerve plexuspreserving pancreaticoduodenectomy. Results of this evaluation were used to review operation procedures and perioperative methods. Method:We divided the MUP into 4 sections and stained each section with a different color. These sections were the pancreatic head nerve plexus margin (Area A), portal vein groove margin (Area B), superior mesenteric artery margin (Area C), and left of the superior mesenteric artery margin (Area D). The subjects evaluated were 45 patients who had carcinoma of the pancreatic head and were treated with circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Results

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Section: Discussioncontrasting

confidence: 74%

Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas

et al. 2017

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“…All specimens were analyzed according to a standardized pathological protocol using multicolor inking of the resection margins [16]. The resection was considered curative (R0) if no tumor cells were identified in any of the resection margins.…”

Section: Methodsmentioning

confidence: 99%

Resection of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinomas after Neoadjuvant Chemotherapy

et al. 2015

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Objective: To report the outcomes of surgical resection of borderline resectable (BL) and locally advanced (LA) ‘unresectable' pancreatic cancer after neoadjuvant chemotherapy. Methods: A review of a prospectively maintained database for pancreatic resections was undertaken to identify patients undergoing resection for BL and LA pancreatic cancer after neoadjuvant chemotherapy between January 2007 and December 2012. Clinicopathological, surgical and survival outcomes were analyzed. Results: A total of 45 patients with LA (n = 34) or BL cancer (n = 11) underwent surgery after a mean (± SD) of 7 ± 4 preoperative chemotherapy cycles. Ninety-day mortality was 6.7%, and overall morbidity was 33.3%. An R0 resection was achieved in 34 patients, and 4 patients showed a complete pathological response. Overall median postoperative survival was 17 months (21 after the start of neoadjuvant treatment). Overall and disease-free survival was 74.9 and 43.6% at 1 year and 21.2 and 10.3% at 3 years, respectively. In BL cancer patients, the 3-year survival was significantly higher compared to that of LA cancer patients (p = 0.02). Conclusions: Curative intent resection in BL and LA cancer patients after neoadjuvant chemotherapy can be achieved with reasonable mortality and morbidity and an encouraging 3-year survival. After neoadjuvant therapy, resection provides a better overall survival for BL compared to LA cancer patients.

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“…This was reinforced by a prospective study that we conducted in 2008, in which the PV margin was the more frequently invaded margin (R1 resection) in patients with resectable (ie, absence of intraoperative PV invasion) pancreatic adenocarcinoma. 3 In conclusion, I believe that retrospective studies starting in the early 2000s are consistent enough to approach answering a question. However, our conclusions are disputable and must be confirmed by a prospective study.…”

Section: To the Editormentioning

confidence: 92%

Should the Portal Vein Be Routinely Resected During Pancreaticoduodenectomy for Adenocarcinoma?

Gallagher

McNally²

2015

Annals of Surgery

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Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens

Abstract: Pancreaticoduodenectomy requiring PV-SMVR was associated with a higher risk for R1 resection. The standardization of histopathological analysis has a clinically relevant impact on PFS data.

Cited by 154 publications

References 59 publications

Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas

Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas

Resection of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinomas after Neoadjuvant Chemotherapy

Should the Portal Vein Be Routinely Resected During Pancreaticoduodenectomy for Adenocarcinoma?

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