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Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens.

ABSTRACT: OBJECTIVES:This study aimed to determine the impact of a standardized pathological protocol on resection margin status after pancreaticoduodenectomy (PD) for ductal adenocarcinoma. METHODS:A total of 150 patients operated during 2008-2010 were included in a prospective multicentre study using a 'quality protocol'. Multicolour inking by the surgeon identified three resection margins: the portal vein-superior mesenteric vein margin (PV-SMVm) or mesenterico-portal vein groove; the superior mesenteric artery margin (SMAm), and the posterior margin. Resection margins were stratified by 0.5-mm increments (range: 0-2.0 mm). Pancreatic neck, bile duct and intestinal margins were also analysed. Correlations between histopathological factors and survival in the 0-mm resection margin group were analysed. RESULTS:Thirty-six patients (24%) had a PV-SMV resection (PV-SMVR). An analysis of resections categorized according to margin distances of 0 mm, <1.0 mm, <1.5 mm and <2.0 mm confirmed R1 resections in 35 (23%), 91 (61%), 94 (63%) and 107 (71%) patients, respectively. The most frequently invaded resection margin was the PV-SMVm (35% of all patients) and PV-SMVR was the only factor correlated with a higher risk for at least one 0-mm positive resection margin on multivariate analysis (P < 0.001). Two-year progression-free survival (PFS) and median PFS time in patients with R0 and R1 resections (at 0 mm), respectively, were 42.0% and 26.5%, and 19.5 months and 10.5 months, respectively (P = 0.02). A positive PV-SMVm and SMAm had significant impact on PFS, whereas a positive posterior margin had no impact. CONCLUSIONS:Pancreaticoduodenectomy requiring PV-SMVR was associated with a higher risk for R1 resection. The standardization of histopathological analysis has a clinically relevant impact on PFS data.

SUBMITTER: Delpero JR

PROVIDER: S-EPMC3892311 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens.

Delpero Jean Robert JR Bachellier Philippe P Regenet Nicolas N Le Treut Yves Patrice YP Paye François F Carrere Nicolas N Sauvanet Alain A Autret Aurélie A Turrini Olivier O Monges-Ranchin Geneviève G Boher Jean Marie JM

HPB : the official journal of the International Hepato Pancreato Biliary Association 20130307 1

<h4>Objectives</h4>This study aimed to determine the impact of a standardized pathological protocol on resection margin status after pancreaticoduodenectomy (PD) for ductal adenocarcinoma.<h4>Methods</h4>A total of 150 patients operated during 2008-2010 were included in a prospective multicentre study using a 'quality protocol'. Multicolour inking by the surgeon identified three resection margins: the portal vein-superior mesenteric vein margin (PV-SMVm) or mesenterico-portal vein groove; the su ...[more]

PMID: 23464850

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Project description:Background:In a pathological examination of pancreaticoduodenectomy for pancreatic head adenocarcinoma, a resection margin without cancer cells in 1?mm is recognized as R0; a resection margin with cancer cells in 1?mm is recognized as R1. The preoperative identification of R0 and R1 is of great significance for surgical decision and prognosis. We conducted a preliminary radiomics study based on preoperative CT (computer tomography) images to evaluate a resection margin which was R0 or R1. Methods:We retrospectively analyzed 258 preoperative CT images of 86 patients (34 cases of R0 and 52 cases of R1) who were diagnosed as pancreatic head adenocarcinoma and underwent pancreaticoduodenectomy. The radiomics study consists of five stages: (i) delineate and segment regions of interest (ROIs); (ii) by solving discrete Laplacian equations with Dirichlet boundary conditions, fit the ROIs to rectangular regions; (iii) enhance the textures of the fitted ROIs combining wavelet transform and fractional differential; (iv) extract texture features from the enhanced ROIs combining wavelet transform and statistical analysis methods; and (v) reduce features using principal component analysis (PCA) and classify the resection margins using the support vector machine (SVM), and then investigate the associations between texture features and histopathological characteristics using the Mann-Whitney U-test. To reduce overfitting, the SVM classifier embedded a linear kernel and adopted the leave-one-out cross-validation. Results:It achieved an AUC (area under receiver operating characteristic curve) of 0.8614 and an accuracy of 84.88%. Setting p ? 0.01 in the Mann-Whitney U-test, two features of the run-length matrix, which are derived from diagonal sub-bands in wavelet decomposition, showed statistically significant differences between R0 and R1. Conclusions:It indicates that the radiomics study is rewarding for the aided diagnosis of R0 and R1. Texture features can potentially enhance physicians' diagnostic ability.

Project description:BACKGROUND AND AIMS: Pancreaticoduodenectomy (PD) is a major operative intervention performed most commonly for malignancy in the head of pancreas. The aim of this study was to evaluate the utilization of blood transfusion for PD and to determine whether this had prognostic significance in a subset of patients with pancreatic ductal adenocarcinoma (PDAC). MATERIAL AND METHODS: Data on blood transfusion requirement were retrospectively collected for patients undergoing PD from 1998 to 2005. Standard prognostic factors and survival data were also collected in patients with PDAC. RESULTS: One-hundred-and-seventy patients underwent PD. Seventy-six patients (45%) received transfusion. The median (interquartile range) number of units of red cell concentrate (RCC) transfused perioperatively (intraoperatively and within 24 h of surgery) was 1.5 (0.5-2.5). The median preoperative haemoglobin (Hb) was 126 g/dl. The median number of units of RCC transfused perioperatively in patients with Hb <126 g/dl was 2 (1-3); for those with Hb > or = 126 g/dl the median was 0 (0-1); p=0.003. Forty-nine patients who were resected for PDAC were subjected to survival analysis. Univariate and multivariate analyses showed that only posterior resection margin invasion was associated with an adverse outcome (margin positive 198 [143-470] days vs margin negative 398 [303-859] days; p=0.02). Perioperative RCC transfusion requirement was not a significant predictor of survival (transfusion 408 [214-769] days vs no transfusion 331 [217-391] days; p=0.18). Furthermore, RCC transfusion within 30 days of operation was not a significant predictor of poor survival (transfusion 331 [201-459] days vs no transfusion 317 [196-769] days; p=0.43). CONCLUSIONS: PD can be performed with a moderately low requirement for RCC transfusion; however, low preoperative haemoglobin is a predictor for the requirement of RCC transfusion. Administration of RCC transfusion does not appear to be a significant adverse prognostic factor in patients with resected PDAC.

Project description:BackgroundResection of pancreatic ductal adenocarcinoma (PDAC) with synchronous liver metastasectomy is still a matter of debate. We aimed to evaluate the feasibility of synchronous resection of PDAC and liver metastases for curative intent at a high-volume surgical center.MethodsPatients who underwent pancreaticoduodenectomy (PD) with synchronous liver metastasectomy (M1 resection group, n = 50) were matched 1 : 1 based on tumor and nodular stage, age, gender, body mass index and concomitant disease with two control groups (M0 resection and M1 no resection). The M0 resection group included patients who underwent PD without metastases. The M1 no resection group included patients with liver metastases who underwent palliative bypass or exploratory laparotomy without resection followed by palliative and adjuvant therapies.ResultsM1 resection group had a longer operation time, larger intraoperative blood loss, and longer postoperative hospital stay than other two groups. R0 resection rate of M1 resection group was similar to that of M0 resection group (92% vs. 94%, p = 1.000). Postoperative complications were comparable between the groups. The overall median survival in M1 resection, M0 resection, and M1 no resection group was 16, 30, and 6 months, respectively. Cumulative survival rates for 1-, 2-, and 3-year of the M1 resection, M0 resection, and M1 no resection group were 63.8%, 29.0%, and 6.7%; 94.0%, 74.4%, and 25.1%; 24.0%, 2.0%, and 0%, respectively. The survival of M1 resection group was worse than that of M0 resection group (p = 0.009), however significantly much better than that of M1 no resection group (p = 0.001). Univariate analysis showed carcinoembryonic antigen >8 ng/ml and non-R0 resection were associated with death. Multivariate analysis revealed that M1 resection group had improved survival compared with M1 no resection group.ConclusionsPD with synchronous liver metastasectomy for oligometastatic PDAC is safe and feasible, it might provide survival benefits for selected patients.

Dataset Information

Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens.

Publications

Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens.

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