Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma

Abstract

The aim of this study is trying to describe more details of superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, to evaluate biological and prognostic implications of tumor budding in this margin, and to provide more evidence for evaluation of R0 surgery in pancreaticoduodenectomy. 46 patients in 5-years period are included in this study. Immunochemistry and immunofluorescence are used to analyze tumor budding and epithelial–mesenchymal transition. Superior mesenteric artery margin might be described from four aspects including location, gross appearance, microscopic appearance and tumor budding. We find that 1mm rule for R1 surgery is more appropriate to predict prognosis (P = 0.009) than 0mm rule (P = 0.141). Expression of cytokeratin in tumor budding is significantly lower than primary tumor (P = 0.001), and it suggests that tumor budding may participate the procedure of epithelial–mesenchymal transition. High-grade tumor budding and decreasing cytokeratin of tumor budding correlate with distant metastasis and has negative influence on prognosis. So superior mesenteric artery margin might be not only an area that tumor cells may invade, but also a pathway for distant metastasis. It is necessary to evaluate superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic cancer.

Prognostic Role of High-Grade Tumor Budding in Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis with a Focus on Epithelial to Mesenchymal Transition

“…Pooling data from five studies [20,21,22,23,24], there was an increased RR of ACM in patients with high grade-TB, which was statistically significant (RR, 1.46; 95% CI, 1.13–1.88, p = 0.004, I 2 = 76%) (Table 1, Figure 2A). In four studies reporting adjusted data from multivariate analysis [20,21,23,25], high grade-TB carried a significantly higher HR of ACM compared to low grade-TB, increasing its statistical significance (HR, 2.65; 95% CI, 1.79–3.91; p < 0.0001; I 2 = 31%) (Table 1, Figure 2B).…”

“…Pooling data from three studies [21,22,23], the presence of high grade-TB increased the RR of ROR with statistical significance (RR, 1.61; 95% CI, 1.05–2.47, p = 0.03, I 2 = 85%) (Table 1, Figure S2).…”

“…Altogether, 131 non-duplicated articles were identified through the literature search. After excluding 100 articles based on title/abstract review, 31 articles were retrieved for full text review and, following the application of the inclusion criteria, six unique articles were considered as eligible for the meta-analysis (Figure S1) [20,21,22,23,24,25].…”

“…The median Newcastle-Ottawa Scale (NOS) score was 7 points (range: 6–8), with no manuscript considered as at high risk of bias (Tables S1 and S2). Two studies reported raw data only (e.g., number of deaths) [22,24] whilst in the 4 studies reporting adjusted analyses, the median number of confounders considered in the multivariate analysis was 4 (Tables S1 and S3) [20,21,23,25]. There was no statistically significant difference between high grade-TB and low grade-TB groups of patients regarding presence of lymph node metastasis or pathologic T stage.…”

“…Using a systematic review-based approach, we found six different manuscripts that simultaneously analyzed TB and EMT in pancreatic ductal adenocarcinoma [20,22,26,27,28,29]. Their main findings have been summarized in Table 2.…”