Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3674–3682 | Cite as

Redefining the Positive Margin in Pancreatic Cancer: Impact on Patterns of Failure, Long-Term Survival and Adjuvant Therapy

  • Arsen Osipov
  • Nicholas Nissen
  • Joanne Rutgers
  • Deepti Dhall
  • Jason Naziri
  • Shefali Chopra
  • Quanlin Li
  • Andrew Eugene Hendifar
  • Richard Tuli
Gastrointestinal Oncology
  • 361 Downloads

Abstract

Purpose

There is debate regarding the definition and clinical significance of margin clearance in pancreatic ductal adenocarcinoma (PDA). A comprehensive archival analysis of surgical resection margins was performed to determine the effect on locoregional recurrence and survival, and the impact of adjuvant therapy in PDA.

Methods

We identified 105 patients with resected PDA. Pancreatic, anterior, bile duct, and posterior surgical resection margins (PM; posterior surface, uncinate and vascular groove) were identified. Three pathologists reviewed all archival surgical specimens and recategorized each margin as tumor at ink/transected, <0.5, 0.5–1, >1–2, or >2 mm from the inked surface. The impact of these and other clinical variables was assessed on local control, disease-free survival (DFS), and overall survival (OS).

Results

Among all margins, PM clearance up to 2 mm was prognostic of DFS (p = 0.01) and OS (p = 0.01). Dichotomizing the PM at 2 mm revealed it to be an independent predictor of local recurrence-free survival [hazard ratio HR] 0.20, 95% confidence interval [CI] 0.048–0.881, p = 0.033), DFS (HR 0.46, 95% CI 0.22–0.96, p = 0.03), and OS (HR 0.31, 95% CI 0.14–0.74, p = 0.008). A margin status of >2 mm was also prognostic of OS in patients who received adjuvant chemotherapy (HR 0.31, 95% CI 0.11–0.89, p = 0.03), however this difference was mitigated in patients receiving adjuvant chemoradiotherapy (HR 0.40, 95% CI 0.10–1.58, p = 0.19).

Conclusion

These data highlight the clinical significance of the PM and the lack of significance of other resection margins. Clearance in excess of 2 mm should be considered to improve long-term clinical outcomes. The use of adjuvant radiotherapy should be strongly considered in patients with PMs <2 mm.

Notes

Disclosure

Arsen Osipov, Nicholas Nissen, Joanne Rutgers, Deepti Dhall, Jason Naziri, Shefali Chopra, Quanlin Li, and Andrew Eugene Hendifar have nothing to disclose.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Arsen Osipov
    • 1
  • Nicholas Nissen
    • 2
  • Joanne Rutgers
    • 3
  • Deepti Dhall
    • 3
  • Jason Naziri
    • 4
  • Shefali Chopra
    • 3
  • Quanlin Li
    • 1
  • Andrew Eugene Hendifar
    • 1
  • Richard Tuli
    • 4
  1. 1.Department of MedicineCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of SurgeryCedars-Sinai Medical CenterLos AngelesUSA
  3. 3.Department of PathologyCedars-Sinai Medical CenterLos AngelesUSA
  4. 4.Department of Radiation OncologyCedars-Sinai Medical CenterLos AngelesUSA

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