Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer: A Single-center Experience With 483 Patients
OBJECTIVE:The aim of this study was to test the hypothesis that intraoperative frozen section (FS) and re-resection results to achieve R0 status are associated with different long-term outcomes in pancreatic cancer patients. BACKGROUND:Recent data have challenged the survival benefit of additional r...
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| Veröffentlicht in: | Annals of surgery 2017-06, Vol.265 (6), p.1219-1225 |
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| container_title | Annals of surgery |
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| creator | Nitschke, Philipp Volk, Andreas Welsch, Thilo Hackl, Jonas Reissfelder, Christoph Rahbari, Mohammad Distler, Marius Saeger, Hans-Detlev Weitz, Jürgen Rahbari, Nuh N |
| description | OBJECTIVE:The aim of this study was to test the hypothesis that intraoperative frozen section (FS) and re-resection results to achieve R0 status are associated with different long-term outcomes in pancreatic cancer patients.
BACKGROUND:Recent data have challenged the survival benefit of additional resection in patients with pancreatic cancer in case of positive FS to achieve clear pathological section (PS).
METHODS:Patients who underwent surgery for exocrine pancreatic malignancy with curative intent were identified from a prospective database. Data were stratified by resection margin (group IFS-R0 → PS-R0; group IIFS-R1 → PS-R0; group IIIFS-R1 → PS-R1). Associations with survival were analyzed by univariate and multivariate analyses.
RESULTS:A total of 483 patients met the inclusion criteria. Of these, 61 patients were excluded due to R2 or Rx status. Three hundred seventeen (75%) patients were allocated to margin group I, 32 (8%) to group II, and 73 (17%) to group III. Median overall survival in group I, II, and III was 29, 36, and 12 months (P < 0.001). There was no significant difference in survival between patients in Group I and II (P = 0.849), whereas patients in group III had significantly poorer outcome than group I (P < 0.001) and II (P = 0.039). The prognostic value of margin group status was confirmed on multivariate analysis (hazard ratio = 1.694, 95% confidence interval 1.175–2.442).
CONCLUSIONS:FS analysis with intraoperative re-resection should be performed routinely in patients undergoing pancreatic cancer surgery with the aim to achieve a R0 resection. |
| doi_str_mv | 10.1097/SLA.0000000000001808 |
| format | Article |
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BACKGROUND:Recent data have challenged the survival benefit of additional resection in patients with pancreatic cancer in case of positive FS to achieve clear pathological section (PS).
METHODS:Patients who underwent surgery for exocrine pancreatic malignancy with curative intent were identified from a prospective database. Data were stratified by resection margin (group IFS-R0 → PS-R0; group IIFS-R1 → PS-R0; group IIIFS-R1 → PS-R1). Associations with survival were analyzed by univariate and multivariate analyses.
RESULTS:A total of 483 patients met the inclusion criteria. Of these, 61 patients were excluded due to R2 or Rx status. Three hundred seventeen (75%) patients were allocated to margin group I, 32 (8%) to group II, and 73 (17%) to group III. Median overall survival in group I, II, and III was 29, 36, and 12 months (P < 0.001). There was no significant difference in survival between patients in Group I and II (P = 0.849), whereas patients in group III had significantly poorer outcome than group I (P < 0.001) and II (P = 0.039). The prognostic value of margin group status was confirmed on multivariate analysis (hazard ratio = 1.694, 95% confidence interval 1.175–2.442).
CONCLUSIONS:FS analysis with intraoperative re-resection should be performed routinely in patients undergoing pancreatic cancer surgery with the aim to achieve a R0 resection.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000001808</identifier><identifier>PMID: 27280512</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Aged ; Female ; Frozen Sections ; Humans ; Intraoperative Care ; Male ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy - methods ; Prognosis ; Survival Rate</subject><ispartof>Annals of surgery, 2017-06, Vol.265 (6), p.1219-1225</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3058-ccda330d6c33c75845534cdcc27e91c0a4bd16518e35a7053913aa25123dc10e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27280512$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nitschke, Philipp</creatorcontrib><creatorcontrib>Volk, Andreas</creatorcontrib><creatorcontrib>Welsch, Thilo</creatorcontrib><creatorcontrib>Hackl, Jonas</creatorcontrib><creatorcontrib>Reissfelder, Christoph</creatorcontrib><creatorcontrib>Rahbari, Mohammad</creatorcontrib><creatorcontrib>Distler, Marius</creatorcontrib><creatorcontrib>Saeger, Hans-Detlev</creatorcontrib><creatorcontrib>Weitz, Jürgen</creatorcontrib><creatorcontrib>Rahbari, Nuh N</creatorcontrib><title>Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer: A Single-center Experience With 483 Patients</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>OBJECTIVE:The aim of this study was to test the hypothesis that intraoperative frozen section (FS) and re-resection results to achieve R0 status are associated with different long-term outcomes in pancreatic cancer patients.
BACKGROUND:Recent data have challenged the survival benefit of additional resection in patients with pancreatic cancer in case of positive FS to achieve clear pathological section (PS).
METHODS:Patients who underwent surgery for exocrine pancreatic malignancy with curative intent were identified from a prospective database. Data were stratified by resection margin (group IFS-R0 → PS-R0; group IIFS-R1 → PS-R0; group IIIFS-R1 → PS-R1). Associations with survival were analyzed by univariate and multivariate analyses.
RESULTS:A total of 483 patients met the inclusion criteria. Of these, 61 patients were excluded due to R2 or Rx status. Three hundred seventeen (75%) patients were allocated to margin group I, 32 (8%) to group II, and 73 (17%) to group III. Median overall survival in group I, II, and III was 29, 36, and 12 months (P < 0.001). There was no significant difference in survival between patients in Group I and II (P = 0.849), whereas patients in group III had significantly poorer outcome than group I (P < 0.001) and II (P = 0.039). The prognostic value of margin group status was confirmed on multivariate analysis (hazard ratio = 1.694, 95% confidence interval 1.175–2.442).
CONCLUSIONS:FS analysis with intraoperative re-resection should be performed routinely in patients undergoing pancreatic cancer surgery with the aim to achieve a R0 resection.</description><subject>Aged</subject><subject>Female</subject><subject>Frozen Sections</subject><subject>Humans</subject><subject>Intraoperative Care</subject><subject>Male</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Prognosis</subject><subject>Survival Rate</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVFPwyAUhYnR6Jz-A2N49KUKpbTUt2WZumSJxmp8bPD2zqFdO4Fu-kv8u2I2jfFBXoCT75wbOIQccXbKWZ6dFZPBKfu1uGJqi_S4jFXEecK2SS-oIkpyEe-RfeeeA5Molu2SvTiLFZM87pGP8XyhwdN2SseNt7pdoNXeLJHeYmTRIXjTNtS3dAAzg186o4XXvnM06EVnl2apa2oaehN82HhHH4yfhVsDFoMEdBiOaM_pgBameaoxgoChpaO3MCxYANeWRImfkAOyM9W1w8PN3if3F6O74VU0ub4cDweTCASTKgKotBCsSkEIyKRKpBQJVABxhjkHppPHiqeSKxRSZ0yKnAut4_B0UQFnKPrkZJ27sO1rh86Xc-MA61o32Hau5CpO01ymggc0WaNgW-csTsuFNXNt30vOyq9KylBJ-beSYDveTOge51j9mL47CIBaA6u2Dt_iXupuhbacoa797P_sTw_Ll9o</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Nitschke, Philipp</creator><creator>Volk, Andreas</creator><creator>Welsch, Thilo</creator><creator>Hackl, Jonas</creator><creator>Reissfelder, Christoph</creator><creator>Rahbari, Mohammad</creator><creator>Distler, Marius</creator><creator>Saeger, Hans-Detlev</creator><creator>Weitz, Jürgen</creator><creator>Rahbari, Nuh N</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer: A Single-center Experience With 483 Patients</title><author>Nitschke, Philipp ; Volk, Andreas ; Welsch, Thilo ; Hackl, Jonas ; Reissfelder, Christoph ; Rahbari, Mohammad ; Distler, Marius ; Saeger, Hans-Detlev ; Weitz, Jürgen ; Rahbari, Nuh N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3058-ccda330d6c33c75845534cdcc27e91c0a4bd16518e35a7053913aa25123dc10e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Female</topic><topic>Frozen Sections</topic><topic>Humans</topic><topic>Intraoperative Care</topic><topic>Male</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Prognosis</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nitschke, Philipp</creatorcontrib><creatorcontrib>Volk, Andreas</creatorcontrib><creatorcontrib>Welsch, Thilo</creatorcontrib><creatorcontrib>Hackl, Jonas</creatorcontrib><creatorcontrib>Reissfelder, Christoph</creatorcontrib><creatorcontrib>Rahbari, Mohammad</creatorcontrib><creatorcontrib>Distler, Marius</creatorcontrib><creatorcontrib>Saeger, Hans-Detlev</creatorcontrib><creatorcontrib>Weitz, Jürgen</creatorcontrib><creatorcontrib>Rahbari, Nuh N</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nitschke, Philipp</au><au>Volk, Andreas</au><au>Welsch, Thilo</au><au>Hackl, Jonas</au><au>Reissfelder, Christoph</au><au>Rahbari, Mohammad</au><au>Distler, Marius</au><au>Saeger, Hans-Detlev</au><au>Weitz, Jürgen</au><au>Rahbari, Nuh N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer: A Single-center Experience With 483 Patients</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>265</volume><issue>6</issue><spage>1219</spage><epage>1225</epage><pages>1219-1225</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:The aim of this study was to test the hypothesis that intraoperative frozen section (FS) and re-resection results to achieve R0 status are associated with different long-term outcomes in pancreatic cancer patients.
BACKGROUND:Recent data have challenged the survival benefit of additional resection in patients with pancreatic cancer in case of positive FS to achieve clear pathological section (PS).
METHODS:Patients who underwent surgery for exocrine pancreatic malignancy with curative intent were identified from a prospective database. Data were stratified by resection margin (group IFS-R0 → PS-R0; group IIFS-R1 → PS-R0; group IIIFS-R1 → PS-R1). Associations with survival were analyzed by univariate and multivariate analyses.
RESULTS:A total of 483 patients met the inclusion criteria. Of these, 61 patients were excluded due to R2 or Rx status. Three hundred seventeen (75%) patients were allocated to margin group I, 32 (8%) to group II, and 73 (17%) to group III. Median overall survival in group I, II, and III was 29, 36, and 12 months (P < 0.001). There was no significant difference in survival between patients in Group I and II (P = 0.849), whereas patients in group III had significantly poorer outcome than group I (P < 0.001) and II (P = 0.039). The prognostic value of margin group status was confirmed on multivariate analysis (hazard ratio = 1.694, 95% confidence interval 1.175–2.442).
CONCLUSIONS:FS analysis with intraoperative re-resection should be performed routinely in patients undergoing pancreatic cancer surgery with the aim to achieve a R0 resection.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27280512</pmid><doi>10.1097/SLA.0000000000001808</doi><tpages>7</tpages></addata></record> |
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| ispartof | Annals of surgery, 2017-06, Vol.265 (6), p.1219-1225 |
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| source | MEDLINE; Journals@Ovid Complete; PubMed Central |
| subjects | Aged Female Frozen Sections Humans Intraoperative Care Male Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - methods Prognosis Survival Rate |
| title | Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer: A Single-center Experience With 483 Patients |
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