Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center
Background The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival. Methods Patie...
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| Veröffentlicht in: | Annals of surgical oncology 2018-06, Vol.25 (6), p.1760-1767 |
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| creator | van Roessel, Stijn Kasumova, Gyulnara G. Tabatabaie, Omidreza Ng, Sing Chau van Rijssen, L. Bengt Verheij, Joanne Najarian, Robert M. van Gulik, Thomas M. Besselink, Marc G. Busch, Olivier R. Tseng, Jennifer F. |
| description | Background
The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival.
Methods
Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan–Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved.
Results
Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, |
| doi_str_mv | 10.1245/s10434-018-6467-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5928169</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>931318101</sourcerecordid><originalsourceid>FETCH-LOGICAL-c535t-1c281d96494b7fac5e00b3730f61f5dbf204b5c03ad01ab36eda64810012b153</originalsourceid><addsrcrecordid>eNp1UUtP3DAQtlCr8mh_AJcq6olLit9JLpXQCkolUJGgZ2viTJagrL21k5X498x2KaWVerLl7zXjj7FjwT8Lqc1pFlwrXXJRl1bbqmz22IEw9KJtLd7Qndu6bKQ1--ww5wfORaW4ecf2ZWONMFV1wOINTPdxjMvBw1hcQ1oOoViMCAmCxwJCV9zOaTNsCD3rJ0zFDQEJYRp87ObYYUA_xdVjQTooftz-kpzPKa4RwityscBA8vfsbQ9jxg_P5xG7uzi_W1yWV9-_flucXZXeKDOVwstadI3VjW6rHrxBzltF0_dW9KZre8l1azxX0HEBrbLYgdW1oBVlS19wxL7sbNdzu8LOU3aC0a3TsIL06CIM7m8kDPduGTfONBRsGzI4eTZI8eeMeXKrIXscRwgY5-wkl0YJxfk269M_1Ic4p0DbOSkrpWrd1EQSO5JPMeeE_cssgrttmW5XpqMy3bZMt53h4-slXhS_2yOC3BEyQWGJ6U_y_12fABkBq24</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>227338498</pqid></control><display><type>article</type><title>Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>van Roessel, Stijn ; Kasumova, Gyulnara G. ; Tabatabaie, Omidreza ; Ng, Sing Chau ; van Rijssen, L. Bengt ; Verheij, Joanne ; Najarian, Robert M. ; van Gulik, Thomas M. ; Besselink, Marc G. ; Busch, Olivier R. ; Tseng, Jennifer F.</creator><creatorcontrib>van Roessel, Stijn ; Kasumova, Gyulnara G. ; Tabatabaie, Omidreza ; Ng, Sing Chau ; van Rijssen, L. Bengt ; Verheij, Joanne ; Najarian, Robert M. ; van Gulik, Thomas M. ; Besselink, Marc G. ; Busch, Olivier R. ; Tseng, Jennifer F.</creatorcontrib><description><![CDATA[Background
The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival.
Methods
Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan–Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved.
Results
Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, < 1, and ≥1 mm, respectively (all log-rank
p
< 0.001). On multivariate analysis, patients with a margin clearance of ≥1 mm demonstrated a survival advantage relative to those with 0 mm clearance [hazard ratio (HR) 0.71,
p
< 0.01], whereas survival was comparable for patients with a margin clearance of < 1 mm versus 0 mm (HR: 0.93,
p
= 0.60). Patients with involvement (0 or < 1 mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7 months) relative to those with SMA involvement (17.5 months).
Conclusions
In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of ≥1 mm correlates with improved survival relative to < 1 mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival.]]></description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-018-6467-9</identifier><identifier>PMID: 29651577</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adenocarcinoma ; Aged ; Carcinoma, Pancreatic Ductal - surgery ; Europe ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Margins of Excision ; Medicine ; Medicine & Public Health ; Mesenteric Artery, Superior - pathology ; Middle Aged ; Mortality ; Multivariate analysis ; Neoplasm, Residual ; Oncology ; Pancreatic cancer ; Pancreatic Neoplasms - surgery ; Pancreatic Tumors ; Pancreaticoduodenectomy ; Pathology ; Portal Vein - pathology ; Progression-Free Survival ; Proportional Hazards Models ; Retrospective Studies ; Surgery ; Surgical Oncology ; Survival ; Survival Rate ; Tumors ; United States</subject><ispartof>Annals of surgical oncology, 2018-06, Vol.25 (6), p.1760-1767</ispartof><rights>The Author(s) 2018</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c535t-1c281d96494b7fac5e00b3730f61f5dbf204b5c03ad01ab36eda64810012b153</citedby><cites>FETCH-LOGICAL-c535t-1c281d96494b7fac5e00b3730f61f5dbf204b5c03ad01ab36eda64810012b153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-018-6467-9$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-018-6467-9$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29651577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Roessel, Stijn</creatorcontrib><creatorcontrib>Kasumova, Gyulnara G.</creatorcontrib><creatorcontrib>Tabatabaie, Omidreza</creatorcontrib><creatorcontrib>Ng, Sing Chau</creatorcontrib><creatorcontrib>van Rijssen, L. Bengt</creatorcontrib><creatorcontrib>Verheij, Joanne</creatorcontrib><creatorcontrib>Najarian, Robert M.</creatorcontrib><creatorcontrib>van Gulik, Thomas M.</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><creatorcontrib>Busch, Olivier R.</creatorcontrib><creatorcontrib>Tseng, Jennifer F.</creatorcontrib><title>Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description><![CDATA[Background
The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival.
Methods
Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan–Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved.
Results
Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, < 1, and ≥1 mm, respectively (all log-rank
p
< 0.001). On multivariate analysis, patients with a margin clearance of ≥1 mm demonstrated a survival advantage relative to those with 0 mm clearance [hazard ratio (HR) 0.71,
p
< 0.01], whereas survival was comparable for patients with a margin clearance of < 1 mm versus 0 mm (HR: 0.93,
p
= 0.60). Patients with involvement (0 or < 1 mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7 months) relative to those with SMA involvement (17.5 months).
Conclusions
In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of ≥1 mm correlates with improved survival relative to < 1 mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival.]]></description><subject>Adenocarcinoma</subject><subject>Aged</subject><subject>Carcinoma, Pancreatic Ductal - surgery</subject><subject>Europe</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mesenteric Artery, Superior - pathology</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neoplasm, Residual</subject><subject>Oncology</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreatic Tumors</subject><subject>Pancreaticoduodenectomy</subject><subject>Pathology</subject><subject>Portal Vein - pathology</subject><subject>Progression-Free Survival</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tumors</subject><subject>United States</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1UUtP3DAQtlCr8mh_AJcq6olLit9JLpXQCkolUJGgZ2viTJagrL21k5X498x2KaWVerLl7zXjj7FjwT8Lqc1pFlwrXXJRl1bbqmz22IEw9KJtLd7Qndu6bKQ1--ww5wfORaW4ecf2ZWONMFV1wOINTPdxjMvBw1hcQ1oOoViMCAmCxwJCV9zOaTNsCD3rJ0zFDQEJYRp87ObYYUA_xdVjQTooftz-kpzPKa4RwityscBA8vfsbQ9jxg_P5xG7uzi_W1yWV9-_flucXZXeKDOVwstadI3VjW6rHrxBzltF0_dW9KZre8l1azxX0HEBrbLYgdW1oBVlS19wxL7sbNdzu8LOU3aC0a3TsIL06CIM7m8kDPduGTfONBRsGzI4eTZI8eeMeXKrIXscRwgY5-wkl0YJxfk269M_1Ic4p0DbOSkrpWrd1EQSO5JPMeeE_cssgrttmW5XpqMy3bZMt53h4-slXhS_2yOC3BEyQWGJ6U_y_12fABkBq24</recordid><startdate>20180601</startdate><enddate>20180601</enddate><creator>van Roessel, Stijn</creator><creator>Kasumova, Gyulnara G.</creator><creator>Tabatabaie, Omidreza</creator><creator>Ng, Sing Chau</creator><creator>van Rijssen, L. Bengt</creator><creator>Verheij, Joanne</creator><creator>Najarian, Robert M.</creator><creator>van Gulik, Thomas M.</creator><creator>Besselink, Marc G.</creator><creator>Busch, Olivier R.</creator><creator>Tseng, Jennifer F.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</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>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180601</creationdate><title>Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center</title><author>van Roessel, Stijn ; Kasumova, Gyulnara G. ; Tabatabaie, Omidreza ; Ng, Sing Chau ; van Rijssen, L. Bengt ; Verheij, Joanne ; Najarian, Robert M. ; van Gulik, Thomas M. ; Besselink, Marc G. ; Busch, Olivier R. ; Tseng, Jennifer F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c535t-1c281d96494b7fac5e00b3730f61f5dbf204b5c03ad01ab36eda64810012b153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adenocarcinoma</topic><topic>Aged</topic><topic>Carcinoma, Pancreatic Ductal - surgery</topic><topic>Europe</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mesenteric Artery, Superior - pathology</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Neoplasm, Residual</topic><topic>Oncology</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreatic Tumors</topic><topic>Pancreaticoduodenectomy</topic><topic>Pathology</topic><topic>Portal Vein - pathology</topic><topic>Progression-Free Survival</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Tumors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Roessel, Stijn</creatorcontrib><creatorcontrib>Kasumova, Gyulnara G.</creatorcontrib><creatorcontrib>Tabatabaie, Omidreza</creatorcontrib><creatorcontrib>Ng, Sing Chau</creatorcontrib><creatorcontrib>van Rijssen, L. Bengt</creatorcontrib><creatorcontrib>Verheij, Joanne</creatorcontrib><creatorcontrib>Najarian, Robert M.</creatorcontrib><creatorcontrib>van Gulik, Thomas M.</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><creatorcontrib>Busch, Olivier R.</creatorcontrib><creatorcontrib>Tseng, Jennifer F.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Roessel, Stijn</au><au>Kasumova, Gyulnara G.</au><au>Tabatabaie, Omidreza</au><au>Ng, Sing Chau</au><au>van Rijssen, L. Bengt</au><au>Verheij, Joanne</au><au>Najarian, Robert M.</au><au>van Gulik, Thomas M.</au><au>Besselink, Marc G.</au><au>Busch, Olivier R.</au><au>Tseng, Jennifer F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2018-06-01</date><risdate>2018</risdate><volume>25</volume><issue>6</issue><spage>1760</spage><epage>1767</epage><pages>1760-1767</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract><![CDATA[Background
The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival.
Methods
Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan–Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved.
Results
Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, < 1, and ≥1 mm, respectively (all log-rank
p
< 0.001). On multivariate analysis, patients with a margin clearance of ≥1 mm demonstrated a survival advantage relative to those with 0 mm clearance [hazard ratio (HR) 0.71,
p
< 0.01], whereas survival was comparable for patients with a margin clearance of < 1 mm versus 0 mm (HR: 0.93,
p
= 0.60). Patients with involvement (0 or < 1 mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7 months) relative to those with SMA involvement (17.5 months).
Conclusions
In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of ≥1 mm correlates with improved survival relative to < 1 mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival.]]></abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29651577</pmid><doi>10.1245/s10434-018-6467-9</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2018-06, Vol.25 (6), p.1760-1767 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adenocarcinoma Aged Carcinoma, Pancreatic Ductal - surgery Europe Female Humans Kaplan-Meier Estimate Male Margins of Excision Medicine Medicine & Public Health Mesenteric Artery, Superior - pathology Middle Aged Mortality Multivariate analysis Neoplasm, Residual Oncology Pancreatic cancer Pancreatic Neoplasms - surgery Pancreatic Tumors Pancreaticoduodenectomy Pathology Portal Vein - pathology Progression-Free Survival Proportional Hazards Models Retrospective Studies Surgery Surgical Oncology Survival Survival Rate Tumors United States |
| title | Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center |
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