Impact of resection margin status on recurrence and survival in pancreatic cancer surgery

W S Tummers; J V Groen; B G Sibinga Mulder; A Farina-Sarasqueta; J Morreau; H Putter; C J van de Velde; A L Vahrmeijer; B A Bonsing; J S Mieog; R J Swijnenburg

doi:10.1002/bjs.11115

journal article Open Access Mar 18, 2019

Impact of resection margin status on recurrence and survival in pancreatic cancer surgery

W S Tummers

J V Groen B G Sibinga Mulder

A Farina-Sarasqueta J Morreau H Putter C J van de Velde A L Vahrmeijer

B A Bonsing J S Mieog

R J Swijnenburg

British Journal of Surgery Vol. 106 No. 8 pp. 1055-1065 · Oxford University Press (OUP)

View at Publisher Save 10.1002/bjs.11115

Abstract

AbstractBackgroundThe prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is poor and selection of patients for surgery is challenging. This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics and/or technical factors associated with a positive resection margin in patients with PDAC.MethodsPatients scheduled for pancreatic resection for PDAC between 2006 and 2016 were identified from an institutional database. The effect of resection margin status, patient characteristics and tumour characteristics on LRR, distant metastasis and OS was assessed.ResultsA total of 322 patients underwent pancreatectomy for PDAC. A positive resection (R1) margin was found in 129 patients (40·1 per cent); this was associated with decreased OS compared with that in patients with an R0 margin (median 15 (95 per cent c.i. 13 to 17) versus 22 months; P &lt; 0·001). R1 status was associated with reduced time to LRR (median 16 versus 36 (not estimated, n.e.) months; P = 0·002). Disease recurrence patterns were similar in the R1 and R0 groups. Risk factors for early recurrence were tumour stage, positive lymph nodes (N1) and perineural invasion. Among 100 patients with N0 disease, R1 status was associated with shorter OS compared with R0 resection (median 17 (10 to 24) versus 45 (n.e.) months; P = 0·002), whereas R status was not related to OS in 222 patients with N1 disease (median 14 (12 to 16) versus 17 (15 to 19) months after R1 and R0 resection respectively; P = 0·068).ConclusionAlthough pancreatic resection with a positive margin was associated with poor survival and early recurrence, particularly in patients with N1 disease, disease recurrence patterns were similar between R1 and R0 groups.

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Metrics

191

Citations

42

References

Details

Published: Mar 18, 2019
Vol/Issue: 106(8)
Pages: 1055-1065
License: View

Authors

W

W S Tummers

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

J

J V Groen

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

B

B G Sibinga Mulder

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

A

A Farina-Sarasqueta

Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands

J

J Morreau

Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands

H

H Putter

Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands

C

C J van de Velde

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

A

A L Vahrmeijer

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

B

B A Bonsing

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

J

J S Mieog

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

R

R J Swijnenburg

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

Funding

Ketel 1 Study Funds Foundation

Lisa Waller Hayes Foundation

Michael- van Vloten funds

the Stichting de Drie Lichten

Cite This Article

W S Tummers, J V Groen, B G Sibinga Mulder, et al. (2019). Impact of resection margin status on recurrence and survival in pancreatic cancer surgery. British Journal of Surgery, 106(8), 1055-1065. https://doi.org/10.1002/bjs.11115

Impact of resection margin status on recurrence and survival in pancreatic cancer surgery

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