scholarly journals Prospective Evaluation of Resection Margins Using Standardized Specimen Protocol Analysis among Patients with Distal Cholangiocarcinoma and Pancreatic Ductal Adenocarcinoma

2021 ◽  
Vol 10 (15) ◽  
pp. 3247
Author(s):  
Jonathan Garnier ◽  
Jacques Ewald ◽  
Flora Poizat ◽  
Eddy Traversari ◽  
Ugo Marchese ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Resection Margin ◽  
Protocol Analysis ◽  
Neoadjuvant Treatment ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Resection Rate ◽  
Venous Resection ◽  
Distal Cholangiocarcinoma ◽  
R1 Resection

Purpose: Using a standardized specimen protocol analysis, this study aimed to evaluate the resection margin status of patients who underwent resection for either distal cholangiocarcinoma (DC) or pancreatic ductal adenocarcinoma (PDAC). This allowed a precise millimetric analysis of each inked margin. Methods: From 2010 to 2018, 355 consecutively inked specimens from patients with PDAC (n = 288) or DC (n = 67) were prospectively assessed. We assessed relationships between the tumor and the following margins: transection of the pancreatic neck, bile duct, posterior surface, margin toward superior mesenteric artery, and the surface of superior mesenteric vein/portal vein groove. Resection margins were evaluated using a predefined cut-off value of 1 mm; however, clearances of 0 and 1.5 mm were also evaluated. Results: Patients with DC were mostly men (64% vs. 49%, p = 0.028), of older age (68 yo vs. 65, p = 0.033), required biliary stenting more frequently (93% vs. 77%, p < 0.01), and received less neoadjuvant treatment (p < 0.001) than patients with PDAC. The venous resection rate was higher among patients with PDAC (p = 0.028). Postoperative and 90-day mortality rates were comparable. Patients with PDAC had greater tumor size (28.6 vs. 24 mm, p = 0.01) than those with DC. The R1 resection rate was comparable between the two groups, regardless of the clearance margin. Among the three types of resection margins, a venous groove was the most frequent in both entities. In multivariate analysis, the R1 resection margin did not influence patient survival in either PDAC or DC. Conclusion: Our standardized specimen protocol analysis showed that the R1 resection rate was comparable in PDAC and DC.

Predicting Surgical Margins in Patients With Borderline Resectable and Locally Advanced Pancreatic Cancer Undergoing Resection

2021 ◽  
pp. 000313482110111
Author(s):  
Weizheng Ren ◽  
Dimitrios Xourafas ◽  
Stanley W. Ashley ◽  
Thomas E. Clancy
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Borderline Resectable ◽  
Stepwise Selection ◽  
R1 Resection ◽  
Positive Resection Margins

Background Many patients with borderline resectable/locally advanced pancreatic ductal adenocarcinoma (borderline resectable [BR]/locally advanced [LA] pancreatic ductal adenocarcinoma [PDAC]) undergoing resection will have positive resection margins (R1), which is associated with poor prognosis. It might be useful to preoperatively predict the margin (R) status. Methods Data from patients with BR/LA PDAC who underwent a pancreatectomy between 2008 and 2018 at Brigham and Women’s Hospital were retrospectively reviewed. Logistic regression analysis was used to evaluate the association between R status and relevant preoperative factors. Significant predictors of R1 resection on univariate analysis ( P < .1) were entered into a stepwise selection using the Akaike information criterion to define the final model. Results A total of 142 patients with BR/LA PDAC were included in the analysis, 60(42.3%) had R1 resections. In stepwise selection, the following factors were identified as positive predictors of an R1 resection: evidence of lymphadenopathy at diagnosis (OR = 2.06, 95% CI: 0.99-4.36, P = .056), the need for pancreaticoduodenectomy (OR = 3.81, 96% CI: 1.15-15.70, P = .040), extent of portal vein/superior mesenteric vein involvement at restaging (<180°, OR = 3.57, 95% CI: 1.00-17.00, P = .069, ≥180°, OR = 7,32, 95% CI: 1.75-39.87, P = .010), stable CA 19-9 serum levels (less than 50% decrease from diagnosis to restaging, OR = 2.27, 95% CI: 0.84-6.36 P = .107), and no preoperative FOLFIRINOX (OR = 2.17, 95% CI: 0.86-5.64, P = .103). The prognostic nomogram based on this model yielded a probability of achieving an R1 resection ranging from <5% (0 factors) to >70% (all 5 factors). Conclusions Relevant preoperative clinicopathological characteristics accurately predict positive resection margins in patients with BR/LA PDAC before resection. With further development, this model might be used to preoperatively guide surgical decision-making in patients with BR/LA PDAC.

Retrospective determination of the correlation between the distance of tumor manifestation to peripancreatic arteries and overall survival in primary resected pancreatic ductal adenocarcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15745-e15745
Author(s):  
Uwe A Wittel ◽  
Michael Uhl ◽  
Frank Makowiec ◽  
Ulrich Theodor Hopt ◽  
Stefan Fichtner-Feigl ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Median Survival ◽  
Average Distance ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Resection Margins ◽  
R0 Resection ◽  
Borderline Resectable ◽  
R1 Resection

e15745 Background: Current guidelines determine the resectability of PDAC by evaluating the contact of the tumor to peripancreatic vasculature. We wanted to evaluate the influence of this distance of the tumor to peripancreatic arteries on the overall survival of patients with primary resection of pancreatic ductal adenocarcinoma. Methods: Preoperative radiographs of 208 consecutive patients after distal pancreatectomy and/or pancreatoduodenectomy operated between 2007 and 2014 were included in the analysis. In reconstructions of CT and MRI data 90° planes to the centerline of the celiac trunc (CT), hepatic artery(HA) and superior mesenteric artery(SMA) were computed with Aquarius Intuition Viewer (V4.4.11, Terarecon). The closest distance between the tumor and the CT /HA and SMA was determined by an experienced pancreatic surgeon and radiologist independently and upon a deviation greater than 3 mm consent was reached by additional review in 33,2% (69/208) of the cases. Results: 176 CT and 32 MRI scans of 208 patients were evaluated. 2.4 % (5/208) of the radiographs were excluded due to insufficient quality. Average distance of the tumor to the CT/HA and SMA was 16.3 and 6.5 mm for PD and 12.7 and 11.0 mm for DP. Distance between the artery and the tumor did not influence the R0 resection rates (overall R0 > 1mm resection margin 64%) and median overall survival was 24.0 months after R0 resection and 13.5 months after R1 resection (log-rank test P < 0.05). Borderline resectable patients (n = 57) showed a median survival of 13.4 months, patients with their tumor 1-5mm distant to the closest artery (n = 65) and greater than 5 mm distance (n = 81) showed a median survival of 20.3 and 32.9 months respectively. Patients with 0-5 and greater than 5 mm distance between arteries and tumor showed a survival benefit from R0 resection (R0/R1 0-5mm 20.3/13.5 months; > 5mm 37.3/12.8 months) while R0 resected borderline resectable patients showed a similar survival than R1 resected patients (R0 12.7months, R1 15.1 months). Conclusions: The negative resection margins in borderline resectable patients not increase the survival when compared to R1 resected patients. Patients with primary R0 resection and initially large distance of the tumor to peripancreatic vasculature show a prolonged survival.

scholarly journals Clinical Outcome of RAMPS for Left-Sided Pancreatic Ductal Adenocarcinoma: A Comparison of Anterior RAMPS Versus Posterior RAMPS for Patients without Periadrenal Infiltration

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1291
Author(s):  
Jaewoo Kwon ◽  
Yejong Park ◽  
Eunsung Jun ◽  
Woohyung Lee ◽  
Ki-Byung Song ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Survival Data ◽  
Survival Rates ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Perioperative Outcomes ◽  
Free Survival ◽  
R1 Resection ◽  
Radical Antegrade Modular Pancreatosplenectomy

Radical antegrade modular pancreatosplenectomy (RAMPS) is considered an effective procedure for left-sided pancreatic ductal adenocarcinoma (PDAC). However, whether there are differences in perioperative outcomes, pathologies, or survival outcomes between anterior RAMPS (aRAMPS) and posterior RAMPS (pRAMPS) has not been reported previously. We retrospectively reviewed and compared the demographic, perioperative, histopathologic, and survival data of patients who underwent aRAMPS or pRAMPS for PDAC. We also compared these two groups among patients without periadrenal infiltration or adrenal invasion. A total of 112 aRAMPS patients and 224 pRAMPS patients were evaluated. Periadrenal infiltration, neoadjuvant treatment, and concurrent vessel resection were more prevalent in the pRAMPS group. After excluding patients with periadrenal infiltration, 106 aRAMPS patients were compared with 157 pRAMPS patients. There were no significant differences between the aRAMPS and pRAMPS groups in the pathologic tumor size, resection margin, proportion of tangential margin in the R1 resection, and number of harvested lymph nodes. The median overall survival and disease-free survival also did not differ significantly between the two groups. We cautiously suggest that pRAMPS will not necessarily provide more beneficial histopathologic outcomes and survival rates for left-sided PDAC cases without periadrenal infiltration. If periadrenal infiltration is not suspected, aRAMPS alone should be sufficiently effective.

scholarly journals 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

2021 ◽  
Author(s):  
Bo Li ◽  
Shiwei Guo ◽  
Xiaohan Shi ◽  
Chenming Ni ◽  
Suizhi Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Resection Margin ◽  
Tnm Staging ◽  
Ductal Adenocarcinoma ◽  
Pathological Examination ◽  
Multivariate Logistic Regression ◽  
R1 Resection ◽  
Independent Risk Factors

Abstract Background/Objectives: The present study identified the independent risk factors of R1 resection in pancreaticoduodenectomy (PD) and distal pancreatosplenectomy (DP) for patients with pancreatic ductal adenocarcinoma (PDAC).Methods：Consecutive patients who were operated from 1st December 2017 to 30th December 2018 with curative intent were analyzed retrospectively. A standardized pathological examination with digital whole-mount slide images (DWMSIs) was utilized for the resection margin status. R1 was defined as microscopic tumor infiltration within 1 mm to the resection margin. The potential risk factors of R1 resection for PD and DP were analyzed separately by univariate and multivariate logistic regression analyses. Results：For the 240 patients who underwent PD, and the 146 patients who underwent DP, the R1 resection rates were 30.8% and 35.6 %, respectively. Univariate analysis on risk factors of R1 resection for PD were tumor location, absence of tumor necrosis, N staging, and TNM staging; while those for DP were perineural invasion, T staging, and TNM staging. Multivariate logistic regression analysis showed the location of tumor in the neck and uncinate process, and N1/2 staging were independent risk factors of R1 resection for PD; while those for DP were T3/4 staging. Conclusions：The clarification of the risk factors of R1 resection might clearly make surgeons take better decisions on surgical strategies for different surgical precedures in patients with PDAC.

scholarly journals In the Era of the Leeds Protocol: A Systematic Review and A Meta-Analysis on the Effect of Resection Margins on Survival Among Pancreatic Ductal Adenocarcinoma Patients

2020 ◽  
Vol 109 (1) ◽  
pp. 11-17
Author(s):  
B. Kurlinkus ◽  
R. Ahola ◽  
E. Zwart ◽  
A. Halimi ◽  
B. S. Yilmaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Resection Margin ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Systematic Search ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Inverse Variance ◽  
The Impact

Background and Aims: A positive resection margin is considered to be a factor associated with poor prognosis after pancreatic ductal adenocarcinoma resection. However, analysis of the resection margin is dependent on the pathological slicing technique. The aim of this systematic review and meta-analysis was to study the impact of resection margin on the survival of pancreatic ductal adenocarcinoma patients whose specimens were analyzed using the axial slicing technique. Material and Methods: A systematic search in the PubMed, Cochrane, and Embase datasets covering the time period from November 2006 to January 2019 was performed. Only studies with axial slicing technique (Leeds Pathology Protocol or Royal College of Pathology Protocol) were included in the final database. Meta-analysis between the marginal distance and survival was performed with the Inverse Variance Method in RevMan. Results: The systematic search resulted in nine studies meeting the inclusion criteria. The median survival for a resection margin 0 mm ranged from 12.3 to 23.4 months, for resection margin <0.5 mm 16 months, for resection margin <1 mm ranged from 11 to 27.5 months, for resection margin <1.5 mm ranged from 16.9 to 21.2 months, and for resection margin >2 mm ranged from 53.9 to 63.1 months. Five studies were eligible for meta-analysis. The pooled multivariable hazard ratio favored resection margin ⩾1 mm (hazard ratio: 1.32 and 95% confidence interval: 1.03–1.68, p = 0.03). Conclusion: Resection margins ⩾1 mm seem to lead to better survival in pancreatic ductal adenocarcinoma patients than resection margin <1 mm. However, there is not enough data to evaluate the effect of oncologic therapy or to analyze the impact of other resection margin distances on survival.

Intra-pancreatic distal cholangiocarcinoma and pancreatic ductal adenocarcinoma: a common short and long-term prognosis?

2021 ◽  
Author(s):  
Théophile Guilbaud ◽  
Edouard Girard ◽  
Coralie Lemoine ◽  
Ghislain Schlienger ◽  
Oyekashopefoluw Alao ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma ◽  
Distal Cholangiocarcinoma ◽  
Short And Long Term ◽  
Long Term Prognosis

scholarly journals High Clinical Value of Liquid Biopsy to Detect Circulating Tumor Cells and Tumor Exosomes in Pancreatic Ductal Adenocarcinoma Patients Eligible for Up-Front Surgery

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1656 ◽  
Author(s):  
Etienne Buscail ◽  
Catherine Alix-Panabières ◽  
Pascaline Quincy ◽  
Thomas Cauvin ◽  
Alexandre Chauvet ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Liquid Biopsy ◽  
Neoadjuvant Treatment ◽  
Digital Pcr ◽  
Portal Blood ◽  
Ductal Adenocarcinoma ◽  
Clinical Value ◽  
Liquid Biopsies

Purpose: Expediting the diagnosis of pancreatic ductal adenocarcinoma (PDAC) would benefit care management, especially for the start of treatments requiring histological evidence. This study evaluated the combined diagnostic performance of circulating biomarkers obtained by peripheral and portal blood liquid biopsy in patients with resectable PDAC. Experimental design: Liquid biopsies were performed in a prospective translational clinical trial (PANC-CTC #NCT03032913) including 22 patients with resectable PDAC and 28 noncancer controls from February to November 2017. Circulating tumor cells (CTCs) were detected using the CellSearch® method or after RosetteSep® enrichment combined with CRISPR/Cas9-improved KRAS mutant alleles quantification by droplet digital PCR. CD63 bead-coupled Glypican-1 (GPC1)-positive exosomes were quantified by flow cytometry. Results: Liquid biopsies were positive in 7/22 (32%), 13/22 (59%), and 14/22 (64%) patients with CellSearch® or RosetteSep®-based CTC detection or GPC1-positive exosomes, respectively, in peripheral and/or portal blood. Liquid biopsy performance was improved in portal blood only with CellSearch®, reaching 45% of PDAC identification (5/11) versus 10% (2/22) in peripheral blood. Importantly, combining CTC and GPC1-positive-exosome detection displayed 100% of sensitivity and 80% of specificity, with a negative predictive value of 100%. High levels of GPC1+-exosomes and/or CTC presence were significantly correlated with progression-free survival and with overall survival when CTC clusters were found. Conclusion: This study is the first to evaluate combined CTC and exosome detection to diagnose resectable pancreatic cancers. Liquid biopsy combining several biomarkers could provide a rapid, reliable, noninvasive decision-making tool in early, potentially curable pancreatic cancer. Moreover, the prognostic value could select patients eligible for neoadjuvant treatment before surgery. This exploratory study deserves further validation.

The prognostic influence of resection margin clearance following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Pancreatology ◽  
2013 ◽  
Vol 13 (1) ◽  
pp. e15-e16
Author(s):  
Nigel B. Jamieson ◽  
Nigel I.J. Chan ◽  
Alan K. Foulis ◽  
Euan J. Dickson ◽  
Colin J. McKay ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Resection Margin ◽  
Ductal Adenocarcinoma

705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Multimodal Therapy ◽  
Resection Margin ◽  
Locally Advanced ◽  
Radical Resection ◽  
Resection Margins ◽  
R0 Resection ◽  
Term Survival ◽  
R1 Resection

Abstract   Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of &gt;1 mm (R0) and &lt; 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM &gt;1 mm (R0) or &lt; 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

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