Article ; Online: Microscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma.
Archives of surgery (Chicago, Ill. : 1960)
2012 Volume 147, Issue 8, Page(s) 753–760
Abstract: Objective: To correlate microscopic margin status with survival and local control in a large cohort of patients from a high-volume pancreatic cancer center.: Design: Retrospective database review. A uniform procedure for margin analysis was used with ...
| Abstract | Objective: To correlate microscopic margin status with survival and local control in a large cohort of patients from a high-volume pancreatic cancer center. Design: Retrospective database review. A uniform procedure for margin analysis was used with 4-color inking (neck, portal vein groove, uncinate, and posterior pancreatic margin) by the surgeon in the operating room. Setting: A tertiary care hospital. Patients: We reviewed patients who underwent pancreaticoduodenectomy between September 1, 1997, and December 31, 2008, from a prospective, institutional database. Main outcome measures: Using Cox regression models, we identified pathologic characteristics associated with local recurrence (LR) after controlling for potential confounding variables. Overall and LR-free survival curves were generated by the Kaplan-Meier method. Results: Of 285 patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma, 97 (34.0%) had 1 or more positive microscopic margins (uncinate, 16.5%; portal vein groove, 8.8%; neck, 7.7%; and posterior, 10.5%). A total of 198 patients (69.5%) recurred, with the first site of failure being LR only in 47 (23.7%), local plus distant recurrence in 42 (21.2%), and distant recurrence only in 109 (55.1%). Patients with LR only were significantly more likely to have lymph node involvement (adjusted hazard ratio, 2.66; 95% CI, 1.25-5.63) or a positive posterior margin (adjusted hazard ratio, 4.27; 95% CI, 2.07-8.81). Patients with a positive posterior margin had significantly poorer LR-free survival with (P < .001) or without (P = .01) lymph node involvement. Conclusions: When systematically assessed, the incidence of positive microscopic margins is high. Positive posterior margins and lymph node involvement were each independently and significantly associated with LR. |
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| MeSH term(s) | Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Aged ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/methods ; Treatment Failure | |||||
| Language | English | |||||
| Publishing date | 2012-08 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article ; Research Support, N.I.H., Extramural | |||||
| ZDB-ID | 80055-7 | |||||
| ISSN | 1538-3644 ; 0004-0010 ; 0096-6908 ; 0272-5533 | |||||
| ISSN (online) | 1538-3644 | |||||
| ISSN | 0004-0010 ; 0096-6908 ; 0272-5533 | |||||
| DOI | 10.1001/archsurg.2012.1126 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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