Surgical Margin Status of Patients with Pancreatic Ductal Adenocarcinoma Undergoing Surgery with Radical Intent: Risk Factors for the Survival Impact of Positive Margins

Abstract

Background: For pancreatic ductal adenocarcinoma (PDAC), surgical margin status is an important pathological factor for evaluating surgical adequacy. In this study, we attempted to investigate predictive factors for the survival impact of positive surgical margins. Materials and Methods: From February 2004 to December 2013, 204 patients were diagnosed with PDAC and underwent surgery with radical intent; 189 patients fulfilled our selection criteria and were enrolled for analysis. Results: For the 189 enrolled patients with PDAC, we found male predominance (112/189, 59%) and a median age of 64 years; most patients were diagnosed with stage IIB disease (n=115, 61%). The positive surgical margin rate was 21% (n=40). Carbohydrate antigen 19-9 (CA19-9) level higher than 246 U/ml (odds ratio (OR)=2.318; 95% confidence interval (CI)=1.037-5.181 p=0.040) and lesion location in the uncinate process (OR=2.996; 95% CI=1.232-7.284 p=0.015) were the only two independent risk factors for positive surgical margins. Positive retroperitoneal soft-tissue margins were the most frequently observed (24/40, 60%). Overall, positive surgical margins had no survival impact in the 189 patients with PDAC who underwent surgery; however, positive surgical margins had an unfavorable survival impact on patients with stage IIA PDAC who underwent surgery. Conclusion: Retroperitoneal soft-tissue was the most common site for positive surgical margins. Additionally, surgical margin positivity was more likely for tumors located in the uncinate process than for other tumors. Positive surgical margins had an unfavorable survival impact on patients with stage IIA PDAC who underwent surgery. Pancreatic ductal adenocarcinoma (PDAC) is a dismal condition with poor prognosis. The 5-year overall survival for PDAC may be as low as 1.3% (1). This poor outcome is attributable to advanced disease at diagnosis and inefficient treatment modalities. However, surgical resection remains the mainstream treatment for both primary tumor excision and precise staging for adjuvant treatment. Unfortunately, only 15-20% patients present with resectable disease at diagnosis (2, 3). For resectable PDAC, 5-year overall survival may be improved to up to 18% (4). For resectable PDAC, surgical margin status is an important pathological factor for evaluating surgical adequacy. However, the impact of this status on long-term clinical outcome remains debatable (5, 6). In this study, we attempted to investigate predictive factors for positive surgical margins after surgery with radical intent and the survival impact of surgical margin status. Materials and Methods From February 2004 to December 2013, 204 patients were diagnosed with PDAC and underwent surgery with radical intent. Eleven patients were excluded due to involvement of the superior mesentery artery or occult distant metastasis revealed after laparotomy. Four patients with surgical mortality (4/204, 1.96%, hospital mortality within 30 days after surgery) were also excluded. Therefore, 189 patients were enrolled for analysi...

A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer

“…Regarding longterm outcomes following MI-and open-RAMPS, equivalent overall and recurrence-free survival have been reported. Among several oncological factors, R0 resection rate is known as an important factor that should be achieved to improve survival following surgery for pancreatic cancer (18,19). It is also Several limitations are associated with the present study.…”

Which Factors Are Associated With Positive Resection Margin in Pancreatic Ductal Adenocarcinoma for Different Surgical Procedures? Results Based on a Standard Pathological Evaluation System-retrospective Cohort Study 

“…Our data also showed similar results in PD. Previous studies who demonstrated lesions in the neck (OR = 5.48) or uncinate process (OR = 2.996) [11], tumor size > 30 mm (OR = 1.13) [12] and grade 3 tumors (OR = 4.05) [28] were independent risk factors of R1 resection. However, there were no studies to clarify independent risk factors separately for R1 in PD and DP.…”

Which Factors Are Associated with Positive Resection Margin in Pancreatic Ductal Adenocarcinoma for different surgical procedures? Results Based on a Standard Pathological Evaluation System-Retrospective Cohort Study

“…Our data also showed similar results in PD. Previous studies who demonstrated lesions in the neck (OR=5.48) or uncinate process (OR=2.996) [11], tumor size >30 mm (OR=1.13) [12] and grade 3 tumors (OR=4.05) [28] were independent risk factors of R1 resection. However, there were no studies to clarify independent risk factors separately for R1 in PD and DP.…”

“…The independent risk factors of R1 resection in PD and DP for PDAC have not been extensively investigated. Furthermore, the de nition of R1 and the protocol on pathological examination of resected specimens have not been standardized [11][12][13]. In our high volume pancreatic center, R1 is de ned as detection of any cancer cells within 1 mm of one or more surfaces or margins in the resected specimens.…”