Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Yaojun Zhang, Adam E. Frampton, Patrizia Cohen, Charis Kyriakides, Jan J. Bong, Nagy A. Habib, Duncan R C Spalding, Raida Ahmad, Long R. Jiao

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated. Methods: Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed. Results: For PDAC, the R1 rate was 57. 1 % (48/84) for any margin, 31. 0 % (26/84) for anterior surface, 42. 9 % (36/84) for posterior surface, 29. 8 % (25/84) for medial margin, and 7. 1 % (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17. 2 vs. 28. 7 months, P = 0. 007 and 12. 3 vs. 21. 0 months, P = 0. 019, respectively). For individual margins, only medial positivity had a significant impact on survival (13. 8 vs. 28. 0 months, P < 0. 001), as opposed to involvement in the anterior (19. 7 vs. 23. 3 months, P = 0. 187) or posterior margin (17. 5 vs. 24. 2 months, P = 0. 104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0. 002, HR = 0. 381; 95 % CI 0. 207-0. 701). Conclusion: The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.

Original languageEnglish
Pages (from-to)1875-1882
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number10
DOIs
Publication statusPublished - Sep 2012
Externally publishedYes

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Pancreaticoduodenectomy
Adenocarcinoma
Survival
Neoplasms
Disease-Free Survival
Multivariate Analysis
Margins of Excision
Databases

Keywords

  • Medial resection margin
  • Pancreatic ductal adenocarcinoma
  • Pancreaticoduodenectomy
  • Prognostic factors
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma. / Zhang, Yaojun; Frampton, Adam E.; Cohen, Patrizia; Kyriakides, Charis; Bong, Jan J.; Habib, Nagy A.; Spalding, Duncan R C; Ahmad, Raida; Jiao, Long R.

In: Journal of Gastrointestinal Surgery, Vol. 16, No. 10, 09.2012, p. 1875-1882.

Research output: Contribution to journalArticle

Zhang, Y, Frampton, AE, Cohen, P, Kyriakides, C, Bong, JJ, Habib, NA, Spalding, DRC, Ahmad, R & Jiao, LR 2012, 'Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma', Journal of Gastrointestinal Surgery, vol. 16, no. 10, pp. 1875-1882. https://doi.org/10.1007/s11605-012-1985-4
Zhang, Yaojun ; Frampton, Adam E. ; Cohen, Patrizia ; Kyriakides, Charis ; Bong, Jan J. ; Habib, Nagy A. ; Spalding, Duncan R C ; Ahmad, Raida ; Jiao, Long R. / Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma. In: Journal of Gastrointestinal Surgery. 2012 ; Vol. 16, No. 10. pp. 1875-1882.
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title = "Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma",
abstract = "Background: Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated. Methods: Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed. Results: For PDAC, the R1 rate was 57. 1 {\%} (48/84) for any margin, 31. 0 {\%} (26/84) for anterior surface, 42. 9 {\%} (36/84) for posterior surface, 29. 8 {\%} (25/84) for medial margin, and 7. 1 {\%} (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17. 2 vs. 28. 7 months, P = 0. 007 and 12. 3 vs. 21. 0 months, P = 0. 019, respectively). For individual margins, only medial positivity had a significant impact on survival (13. 8 vs. 28. 0 months, P < 0. 001), as opposed to involvement in the anterior (19. 7 vs. 23. 3 months, P = 0. 187) or posterior margin (17. 5 vs. 24. 2 months, P = 0. 104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0. 002, HR = 0. 381; 95 {\%} CI 0. 207-0. 701). Conclusion: The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.",
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author = "Yaojun Zhang and Frampton, {Adam E.} and Patrizia Cohen and Charis Kyriakides and Bong, {Jan J.} and Habib, {Nagy A.} and Spalding, {Duncan R C} and Raida Ahmad and Jiao, {Long R.}",
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T1 - Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

AU - Zhang, Yaojun

AU - Frampton, Adam E.

AU - Cohen, Patrizia

AU - Kyriakides, Charis

AU - Bong, Jan J.

AU - Habib, Nagy A.

AU - Spalding, Duncan R C

AU - Ahmad, Raida

AU - Jiao, Long R.

PY - 2012/9

Y1 - 2012/9

N2 - Background: Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated. Methods: Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed. Results: For PDAC, the R1 rate was 57. 1 % (48/84) for any margin, 31. 0 % (26/84) for anterior surface, 42. 9 % (36/84) for posterior surface, 29. 8 % (25/84) for medial margin, and 7. 1 % (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17. 2 vs. 28. 7 months, P = 0. 007 and 12. 3 vs. 21. 0 months, P = 0. 019, respectively). For individual margins, only medial positivity had a significant impact on survival (13. 8 vs. 28. 0 months, P < 0. 001), as opposed to involvement in the anterior (19. 7 vs. 23. 3 months, P = 0. 187) or posterior margin (17. 5 vs. 24. 2 months, P = 0. 104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0. 002, HR = 0. 381; 95 % CI 0. 207-0. 701). Conclusion: The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.

AB - Background: Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated. Methods: Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed. Results: For PDAC, the R1 rate was 57. 1 % (48/84) for any margin, 31. 0 % (26/84) for anterior surface, 42. 9 % (36/84) for posterior surface, 29. 8 % (25/84) for medial margin, and 7. 1 % (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17. 2 vs. 28. 7 months, P = 0. 007 and 12. 3 vs. 21. 0 months, P = 0. 019, respectively). For individual margins, only medial positivity had a significant impact on survival (13. 8 vs. 28. 0 months, P < 0. 001), as opposed to involvement in the anterior (19. 7 vs. 23. 3 months, P = 0. 187) or posterior margin (17. 5 vs. 24. 2 months, P = 0. 104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0. 002, HR = 0. 381; 95 % CI 0. 207-0. 701). Conclusion: The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.

KW - Medial resection margin

KW - Pancreatic ductal adenocarcinoma

KW - Pancreaticoduodenectomy

KW - Prognostic factors

KW - Survival

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