Impact of Resection Status on Pattern of Failure and Survival After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

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dc.contributor.author Raut, Chandrajit
dc.contributor.author Tseng, Jennifer
dc.contributor.author Sun, Charlotte
dc.contributor.author Wang, Huamin
dc.contributor.author Wolff, Robert
dc.contributor.author Crane, Christopher
dc.contributor.author Vauthey, Nicolas
dc.contributor.author Abdalla, Eddie
dc.contributor.author Lee, Jeffrey
dc.contributor.author Pisters, Peter
dc.contributor.author Evans, Douglas
dc.date.accessioned 2015-11-16T09:39:17Z
dc.date.available 2015-11-16T09:39:17Z
dc.date.copyright 2007
dc.date.issued 2015-11-16
dc.identifier.issn 0003-4932 en_US
dc.identifier.uri http://hdl.handle.net/10725/2575
dc.description.abstract Objective: To better understand the impact of a microscopically positive margin (R1) on patterns of disease recurrence and survival after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma. Summary Background Data: A positive resection margin after PD is considered to be a poor prognostic factor, and some have proposed that an R1 margin may be a biologic predictor of more aggressive disease. The natural history of patients treated with contemporary multimodality therapy who underwent a positive margin PD has not been described. Methods: We analyzed our experience from 1990 to 2004, which included the prospective use of a standardized system for pathologic analysis of all PD specimens. All patients who underwent PD met objective computed tomographic criteria for resection. Standard pathologic evaluation of the PD specimen included permanent section analysis of the final bile duct, pancreatic, and superior mesenteric artery (SMA) margins. First recurrences (all sites) were defined as local, regional, or distant. Survival and follow-up were calculated from the date of initial histologic diagnosis to the dates of first recurrence or death and last contact, respectively. Results: PD was performed on 360 consecutive patients with pancreatic adenocarcinoma. Minimum follow-up was 12 months (median, 51.9 months). The resection margins were negative (R0) in 300 patients (83.3%) and positive (R1) in 60 (16.7%); no patients had macroscopically positive (R2) margins. By multivariate analysis (MVA), high mean operative blood loss and large tumor size were independent predictors of an R1 resection. Patients who underwent an R1 resection had a median overall survival of 21.5 months compared with 27.8 months in patients who underwent an R0 resection. After controlling for other variables on MVA, resection status did not independently affect survival. By MVA, only lymph node metastases, major perioperative complications, and blood loss adversely affected survival. Conclusions: There was no statistically significant difference in patient survival or recurrence based on R status. However, this series is unique in the incorporation of a standardized surgical technique for the SMA dissection, the prospective use of a reproducible system for pathologic evaluation of resection margins, the absence of R2 resections, and the frequent use of multimodality therapy. en_US
dc.language.iso en en_US
dc.title Impact of Resection Status on Pattern of Failure and Survival After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 20110945 en_US
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Annals of surgery en_US
dc.journal.volume 246 en_US
dc.journal.issue 1 en_US
dc.article.pages 52-60 en_US
dc.identifier.doi http://dx.doi.org/10.1097/01.sla.0000259391.84304.2b en_US
dc.identifier.ctation Raut, C. P., Tseng, J. F., Sun, C. C., Wang, H., Wolff, R. A., Crane, C. H., ... & Evans, D. B. (2007). Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Annals of surgery, 246(1), 52. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://journals.lww.com/annalsofsurgery/Abstract/2007/07000/Impact_of_Resection_Status_on_Pattern_of_Failure.10.aspx

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