Pancreatoduodenectomy for Ductal Adenocarcinoma: Implications of Positive Margin on Survival

Overview

Journal Arch Surg

Publisher American Medical Association

Specialty General Surgery

Date 2010 Feb 17

PMID 20157085

Citations 55

Authors

Javairiah Fatima

Thomas Schnelldorfer

Joshua Barton

Christina M Wood

Heather J Wiste

Thomas C Smyrk

Lizhi Zhang

Michael G Sarr

David M Nagorney

Michael B Farnell

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the effect of R0 resection margin status and R0 en bloc resection in pancreatoduodenectomy outcomes.

Design: Retrospective medical record review.

Setting: Mayo Clinic, Rochester, Minnesota.

Patients: Patients who underwent pancreatoduodenectomy for pancreatic adenocarcinoma at our institution between January 1, 1981, and December 31, 2007, were identified and their medical records were reviewed.

Main Outcome Measure: Median survival times.

Results: A total of 617 patients underwent pancreatoduodenectomy. Median survival times after R0 en bloc resection (n = 411), R0 non-en bloc resection (n = 57), R1 resection (n = 127), and R2 resection (n = 22) were 19, 18, 15, and 10 months, respectively (P < .001). A positive resection margin was associated with death (P = .01). No difference in survival time was found between patients undergoing R0 en bloc and R0 resections after reexcision of an initial positive margin (hazard ratio, 1.19; 95% confidence interval, 0.87-1.64; P = .28).

Conclusions: R0 resection remains an important prognostic factor. Achieving R0 status by initial en bloc resection or reexcision results in similar long-term survival.

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