Presence of low-grade IPMN at the pancreatic transection margin does not have prognostic significance after resection of IPMN-associated pancreatic adenocarcinoma
Resection margin status is a well-established prognosticator in pancreatic cancer. The prognostic impact of IPMN dysplasia at the pancreatic transection margin in IPMN-associated carcinoma (IPMN-Ca) remains unclear, hence institutional practices on additional resections vary. Patients undergoing par...
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| Veröffentlicht in: | European journal of surgical oncology 2023-01, Vol.49 (1), p.113-121 |
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| container_title | European journal of surgical oncology |
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| creator | Leonhardt, Carl-Stephan Hinz, Ulf Kaiser, Jörg Hank, Thomas Tjaden, Christine Bergmann, Frank Hackert, Thilo Büchler, Markus W. Strobel, Oliver |
| description | Resection margin status is a well-established prognosticator in pancreatic cancer. The prognostic impact of IPMN dysplasia at the pancreatic transection margin in IPMN-associated carcinoma (IPMN-Ca) remains unclear, hence institutional practices on additional resections vary.
Patients undergoing partial pancreatectomy or attempted partial pancreatectomy converted to total pancreatectomy for IPMN-Ca between 04/2002 and 12/2018 were identified. Final pathology of the definitive pancreatic transection margin was identified. The association between the presence of IPMN dysplasia at the margin and overall survival (OS) was assessed.
Of 302 patients with IPMN-Ca, 181 (59.9%) patients received partial pancreatoduodenectomy, 61 (20.2%) distal pancreatectomy, and 60 (19.9%) were converted to total pancreatectomy. Median OS was 98.6 months in R0 (≥1 mm), 39.3 months in R1 ( |
| doi_str_mv | 10.1016/j.ejso.2022.08.003 |
| format | Article |
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Patients undergoing partial pancreatectomy or attempted partial pancreatectomy converted to total pancreatectomy for IPMN-Ca between 04/2002 and 12/2018 were identified. Final pathology of the definitive pancreatic transection margin was identified. The association between the presence of IPMN dysplasia at the margin and overall survival (OS) was assessed.
Of 302 patients with IPMN-Ca, 181 (59.9%) patients received partial pancreatoduodenectomy, 61 (20.2%) distal pancreatectomy, and 60 (19.9%) were converted to total pancreatectomy. Median OS was 98.6 months in R0 (≥1 mm), 39.3 months in R1 (<1 mm), and 22.0 months in R1(direct) resected patients, respectively (p < 0.0001). No IPMN dysplasia at the definitive margin was present in 103 (34.1%), low-grade in 131 (43.4%), and high-grade/R1 in 8 (2.6%) patients. Low-grade dysplasia or total pancreatectomy were not associated with shorter OS compared to dysplasia-free margin across the entire cohort. Sensitivity analyses confirmed a lack of prognostic relevance of low-grade IPMN dysplasia at the pancreatic margin in R0 resected IPMN-Ca and in R0 resected UICC stage IA/IB IPMN-Ca.
Low-grade IPMN at the transection margin is not associated with shorter overall survival after partial pancreatectomy for IPMN-Ca. Additional resections for low-grade dysplasia, up to total pancreatectomy do not result in a survival benefit and should be omitted. Due to limited sample size, high-grade dysplasia could not be analyzed.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2022.08.003</identifier><identifier>PMID: 35965217</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adenocarcinoma - pathology ; Carcinoma, Pancreatic Ductal - pathology ; Humans ; IPMN dysplasia ; IPMN-Associated carcinoma ; Pancreatectomy ; Pancreatic ductal adenocarcinoma ; Pancreatic Neoplasms ; Pancreatic Neoplasms - pathology ; Pancreatic transection margin ; Prognosis ; Retrospective Studies</subject><ispartof>European journal of surgical oncology, 2023-01, Vol.49 (1), p.113-121</ispartof><rights>2022 The Authors</rights><rights>Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c351t-7eec9719d39818af003c295cd4ccb9241fd2f5d5c2f55bc7b3264fff48a204993</cites><orcidid>0000-0003-3980-4340 ; 0000-0001-8087-2295 ; 0000-0001-8227-968X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejso.2022.08.003$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35965217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leonhardt, Carl-Stephan</creatorcontrib><creatorcontrib>Hinz, Ulf</creatorcontrib><creatorcontrib>Kaiser, Jörg</creatorcontrib><creatorcontrib>Hank, Thomas</creatorcontrib><creatorcontrib>Tjaden, Christine</creatorcontrib><creatorcontrib>Bergmann, Frank</creatorcontrib><creatorcontrib>Hackert, Thilo</creatorcontrib><creatorcontrib>Büchler, Markus W.</creatorcontrib><creatorcontrib>Strobel, Oliver</creatorcontrib><title>Presence of low-grade IPMN at the pancreatic transection margin does not have prognostic significance after resection of IPMN-associated pancreatic adenocarcinoma</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Resection margin status is a well-established prognosticator in pancreatic cancer. The prognostic impact of IPMN dysplasia at the pancreatic transection margin in IPMN-associated carcinoma (IPMN-Ca) remains unclear, hence institutional practices on additional resections vary.
Patients undergoing partial pancreatectomy or attempted partial pancreatectomy converted to total pancreatectomy for IPMN-Ca between 04/2002 and 12/2018 were identified. Final pathology of the definitive pancreatic transection margin was identified. The association between the presence of IPMN dysplasia at the margin and overall survival (OS) was assessed.
Of 302 patients with IPMN-Ca, 181 (59.9%) patients received partial pancreatoduodenectomy, 61 (20.2%) distal pancreatectomy, and 60 (19.9%) were converted to total pancreatectomy. Median OS was 98.6 months in R0 (≥1 mm), 39.3 months in R1 (<1 mm), and 22.0 months in R1(direct) resected patients, respectively (p < 0.0001). No IPMN dysplasia at the definitive margin was present in 103 (34.1%), low-grade in 131 (43.4%), and high-grade/R1 in 8 (2.6%) patients. Low-grade dysplasia or total pancreatectomy were not associated with shorter OS compared to dysplasia-free margin across the entire cohort. Sensitivity analyses confirmed a lack of prognostic relevance of low-grade IPMN dysplasia at the pancreatic margin in R0 resected IPMN-Ca and in R0 resected UICC stage IA/IB IPMN-Ca.
Low-grade IPMN at the transection margin is not associated with shorter overall survival after partial pancreatectomy for IPMN-Ca. Additional resections for low-grade dysplasia, up to total pancreatectomy do not result in a survival benefit and should be omitted. Due to limited sample size, high-grade dysplasia could not be analyzed.</description><subject>Adenocarcinoma - pathology</subject><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Humans</subject><subject>IPMN dysplasia</subject><subject>IPMN-Associated carcinoma</subject><subject>Pancreatectomy</subject><subject>Pancreatic ductal adenocarcinoma</subject><subject>Pancreatic Neoplasms</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic transection margin</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1uFDEQhC0EIkvgBTggH7nM4J_xeixxQVGASAFygLPlbbc3Xu3awfYG8To8KR5tQJy42Jevqrq7CHnJ2cgZX7_ZjbireRRMiJHNI2PyEVlxJcUguNKPyYrpaR60meUZeVbrjjFmpDZPyZlUZq0E1yvy66ZgxQRIc6D7_GPYFueRXt18-kxdo-0W6Z1LUNC1CLQVlypCiznRgyvbmKjPWGnKjd66-86WvE25LmyN2xRDBLeYu9Cw0CXqJO5hS8Tgas0QXUP_b0yfIGVwBWLKB_ecPAluX_HFw39Ovr2__Hrxcbj-8uHq4t31AFLxNmhEMJobL83MZxf6OUAYBX4C2Bgx8eBFUF5Bf9UG9EaK9RRCmGYn2GSMPCevT759ie9HrM0eYgXc713CfKxWaCamWYt5QcUJhZJrLRjsXYn9ID8tZ3bpxu7s0o1durFstn2YLnr14H_cHND_lfwpowNvTwD2Le8jFlshLt34WPrdrM_xf_6_AX_eo7k</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Leonhardt, Carl-Stephan</creator><creator>Hinz, Ulf</creator><creator>Kaiser, Jörg</creator><creator>Hank, Thomas</creator><creator>Tjaden, Christine</creator><creator>Bergmann, Frank</creator><creator>Hackert, Thilo</creator><creator>Büchler, Markus W.</creator><creator>Strobel, Oliver</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><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><orcidid>https://orcid.org/0000-0003-3980-4340</orcidid><orcidid>https://orcid.org/0000-0001-8087-2295</orcidid><orcidid>https://orcid.org/0000-0001-8227-968X</orcidid></search><sort><creationdate>202301</creationdate><title>Presence of low-grade IPMN at the pancreatic transection margin does not have prognostic significance after resection of IPMN-associated pancreatic adenocarcinoma</title><author>Leonhardt, Carl-Stephan ; Hinz, Ulf ; Kaiser, Jörg ; Hank, Thomas ; Tjaden, Christine ; Bergmann, Frank ; Hackert, Thilo ; Büchler, Markus W. ; Strobel, Oliver</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-7eec9719d39818af003c295cd4ccb9241fd2f5d5c2f55bc7b3264fff48a204993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Carcinoma, Pancreatic Ductal - pathology</topic><topic>Humans</topic><topic>IPMN dysplasia</topic><topic>IPMN-Associated carcinoma</topic><topic>Pancreatectomy</topic><topic>Pancreatic ductal adenocarcinoma</topic><topic>Pancreatic Neoplasms</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic transection margin</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leonhardt, Carl-Stephan</creatorcontrib><creatorcontrib>Hinz, Ulf</creatorcontrib><creatorcontrib>Kaiser, Jörg</creatorcontrib><creatorcontrib>Hank, Thomas</creatorcontrib><creatorcontrib>Tjaden, Christine</creatorcontrib><creatorcontrib>Bergmann, Frank</creatorcontrib><creatorcontrib>Hackert, Thilo</creatorcontrib><creatorcontrib>Büchler, Markus W.</creatorcontrib><creatorcontrib>Strobel, Oliver</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><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>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leonhardt, Carl-Stephan</au><au>Hinz, Ulf</au><au>Kaiser, Jörg</au><au>Hank, Thomas</au><au>Tjaden, Christine</au><au>Bergmann, Frank</au><au>Hackert, Thilo</au><au>Büchler, Markus W.</au><au>Strobel, Oliver</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Presence of low-grade IPMN at the pancreatic transection margin does not have prognostic significance after resection of IPMN-associated pancreatic adenocarcinoma</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2023-01</date><risdate>2023</risdate><volume>49</volume><issue>1</issue><spage>113</spage><epage>121</epage><pages>113-121</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Resection margin status is a well-established prognosticator in pancreatic cancer. The prognostic impact of IPMN dysplasia at the pancreatic transection margin in IPMN-associated carcinoma (IPMN-Ca) remains unclear, hence institutional practices on additional resections vary.
Patients undergoing partial pancreatectomy or attempted partial pancreatectomy converted to total pancreatectomy for IPMN-Ca between 04/2002 and 12/2018 were identified. Final pathology of the definitive pancreatic transection margin was identified. The association between the presence of IPMN dysplasia at the margin and overall survival (OS) was assessed.
Of 302 patients with IPMN-Ca, 181 (59.9%) patients received partial pancreatoduodenectomy, 61 (20.2%) distal pancreatectomy, and 60 (19.9%) were converted to total pancreatectomy. Median OS was 98.6 months in R0 (≥1 mm), 39.3 months in R1 (<1 mm), and 22.0 months in R1(direct) resected patients, respectively (p < 0.0001). No IPMN dysplasia at the definitive margin was present in 103 (34.1%), low-grade in 131 (43.4%), and high-grade/R1 in 8 (2.6%) patients. Low-grade dysplasia or total pancreatectomy were not associated with shorter OS compared to dysplasia-free margin across the entire cohort. Sensitivity analyses confirmed a lack of prognostic relevance of low-grade IPMN dysplasia at the pancreatic margin in R0 resected IPMN-Ca and in R0 resected UICC stage IA/IB IPMN-Ca.
Low-grade IPMN at the transection margin is not associated with shorter overall survival after partial pancreatectomy for IPMN-Ca. Additional resections for low-grade dysplasia, up to total pancreatectomy do not result in a survival benefit and should be omitted. Due to limited sample size, high-grade dysplasia could not be analyzed.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35965217</pmid><doi>10.1016/j.ejso.2022.08.003</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3980-4340</orcidid><orcidid>https://orcid.org/0000-0001-8087-2295</orcidid><orcidid>https://orcid.org/0000-0001-8227-968X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of surgical oncology, 2023-01, Vol.49 (1), p.113-121 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adenocarcinoma - pathology Carcinoma, Pancreatic Ductal - pathology Humans IPMN dysplasia IPMN-Associated carcinoma Pancreatectomy Pancreatic ductal adenocarcinoma Pancreatic Neoplasms Pancreatic Neoplasms - pathology Pancreatic transection margin Prognosis Retrospective Studies |
| title | Presence of low-grade IPMN at the pancreatic transection margin does not have prognostic significance after resection of IPMN-associated pancreatic adenocarcinoma |
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