Microscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma

Jennifer L Gnerlich; Samuel R Luka; Anjali D Deshpande; Bernard J Dubray; Joshua S Weir; Danielle H Carpenter; Elizabeth M Brunt; Steven M Strasberg; William G Hawkins; David C Linehan

doi:10.1001/archsurg.2012.1126

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Microscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma

Journal article

Open access

Peer reviewed

Microscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma

Jennifer L Gnerlich, Samuel R Luka, Anjali D Deshpande, Bernard J Dubray, Joshua S Weir, Danielle H Carpenter, Elizabeth M Brunt, Steven M Strasberg, William G Hawkins and David C Linehan

Archives of surgery (Chicago. 1960), Vol.147(8), pp.753-760

08/2012

DOI: 10.1001/archsurg.2012.1126

PMID: 22911074

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Abstract

To correlate microscopic margin status with survival and local control in a large cohort of patients from a high-volume pancreatic cancer center. 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. A tertiary care hospital. We reviewed patients who underwent pancreaticoduodenectomy between September 1, 1997, and December 31, 2008, from a prospective, institutional database. 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. 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. 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.

Adenocarcinoma - pathology

Humans

Middle Aged

Pancreatic Neoplasms - pathology

Pancreatic Neoplasms - surgery

Kaplan-Meier Estimate

Male

Pancreaticoduodenectomy - methods

Neoplasm Recurrence, Local - pathology

Treatment Failure

Female

Aged

Neoplasm Recurrence, Local - epidemiology

Pancreatic Neoplasms - mortality

Adenocarcinoma - mortality

Adenocarcinoma - surgery

Details

Title: Subtitle: Microscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma
Creators: Jennifer L Gnerlich - Department of Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA
Samuel R Luka
Anjali D Deshpande
Bernard J Dubray
Joshua S Weir
Danielle H Carpenter
Elizabeth M Brunt
Steven M Strasberg
William G Hawkins
David C Linehan
Resource Type: Journal article
Publication Details: Archives of surgery (Chicago. 1960), Vol.147(8), pp.753-760
DOI: 10.1001/archsurg.2012.1126
PMID: 22911074
NLM abbreviation: Arch Surg
ISSN: 1538-3644
eISSN: 1538-3644
Publisher: American Medical Association; United States
Grant note: CA91842 / NCI NIH HHS
Language: English
Date published: 08/2012
Academic Unit: Epidemiology
Record Identifier: 9983995145802771

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