TY - JOUR
T1 - Microscopic resection margin status in pancreatic ductal adenocarcinoma - A nationwide analysis
AU - Daamen, L.A.
AU - van Goor, I.W.J.M.
AU - Schouten, T.J.
AU - Dorland, G.
AU - van Roessel, S.R.
AU - Besselink, M.G.
AU - Bonsing, B.A.
AU - Bosscha, K.
AU - Brosens, L.A.A.
AU - Busch, O.R.
AU - van Dam, R.M.
AU - Sarasqueta, A.F.
AU - Festen, S.
AU - Koerkamp, B.G.
AU - van der Harst, E.
AU - de Hingh, I.H.J.T.
AU - Intven, M.P.W.
AU - Kazemier, G.
AU - de Meijer, V.E.
AU - Nieuwenhuijs, V.B.
AU - Raicu, G.M.
AU - Roos, D.
AU - Schreinemakers, J.M.J.
AU - Stommel, M.W.J.
AU - van Velthuysen, M.F.
AU - Verheij, J.
AU - Verkooijen, H.M.
AU - van Santvoort, H.C.
AU - Molenaar, I.Q.
AU - Dutch Pancreatic Canc Grp
N1 - Publisher Copyright:
© 2020
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Introduction: First, this study aimed to assess the prognostic value of different definitions for resection margin status on disease-free survival (DFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC). Second, preoperative predictors of direct margin involvement were identified.Materials and methods: This nationwide observational cohort study included all patients who underwent upfront PDAC resection (2014-2016), as registered in the prospective Dutch Pancreatic Cancer Audit. Patients were subdivided into three groups: R0 (>= 1 mm margin clearance), R1 (<1 mm margin clearance) or R1 (direct margin involvement). Survival was compared using multivariable Cox regression analysis. Logistic regression with baseline variables was performed to identify preoperative predictors of R1 (direct).Results: 595 patients with a median OS of 18 months (IQR 10-32 months) months were analysed. R0 (>= 1 mm) was achieved in 277 patients (47%), R1 (<1 mm) in 146 patients (24%) and R1 (direct) in 172 patients (29%). R1 (direct) was associated with a worse OS, as compared with both R0 (>= 1 mm) (hazard ratio (HR) 1.35 [95% and confidence interval (CI) 1.08-1.70); P < 0.01) and R1 (<1 mm) (HR 1.29 [95%CI 1.01-1.67]; P < 0.05). No OS difference was found between R0 (>= 1 mm) and R1 (<1 mm) (HR 1.05 [95% CI 0.82-1.34]; P = 0.71). Preoperative predictors associated with an increased risk of R1 (direct) included age, male sex, performance score 2-4, and venous or arterial tumour involvement.Conclusion: Resection margin clearance of <1 mm, but without direct margin involvement, does not affect survival, as compared with a margin clearance of >1 mm. Given that any vascular tumour involvement on preoperative imaging was associated with an increased risk of R1 (direct) resection with upfront surgery, neoadjuvant therapy might be considered in these patients. (C) 2020 Published by Elsevier Ltd.
AB - Introduction: First, this study aimed to assess the prognostic value of different definitions for resection margin status on disease-free survival (DFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC). Second, preoperative predictors of direct margin involvement were identified.Materials and methods: This nationwide observational cohort study included all patients who underwent upfront PDAC resection (2014-2016), as registered in the prospective Dutch Pancreatic Cancer Audit. Patients were subdivided into three groups: R0 (>= 1 mm margin clearance), R1 (<1 mm margin clearance) or R1 (direct margin involvement). Survival was compared using multivariable Cox regression analysis. Logistic regression with baseline variables was performed to identify preoperative predictors of R1 (direct).Results: 595 patients with a median OS of 18 months (IQR 10-32 months) months were analysed. R0 (>= 1 mm) was achieved in 277 patients (47%), R1 (<1 mm) in 146 patients (24%) and R1 (direct) in 172 patients (29%). R1 (direct) was associated with a worse OS, as compared with both R0 (>= 1 mm) (hazard ratio (HR) 1.35 [95% and confidence interval (CI) 1.08-1.70); P < 0.01) and R1 (<1 mm) (HR 1.29 [95%CI 1.01-1.67]; P < 0.05). No OS difference was found between R0 (>= 1 mm) and R1 (<1 mm) (HR 1.05 [95% CI 0.82-1.34]; P = 0.71). Preoperative predictors associated with an increased risk of R1 (direct) included age, male sex, performance score 2-4, and venous or arterial tumour involvement.Conclusion: Resection margin clearance of <1 mm, but without direct margin involvement, does not affect survival, as compared with a margin clearance of >1 mm. Given that any vascular tumour involvement on preoperative imaging was associated with an increased risk of R1 (direct) resection with upfront surgery, neoadjuvant therapy might be considered in these patients. (C) 2020 Published by Elsevier Ltd.
U2 - 10.1016/j.ejso.2020.11.145
DO - 10.1016/j.ejso.2020.11.145
M3 - Article
C2 - 33323293
SN - 0748-7983
VL - 47
SP - 708
EP - 716
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 3
ER -