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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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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Authors and Affiliations

  1. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Arsen Osipov MD, Quanlin Li MS & Andrew Eugene Hendifar MD, MPH

  2. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Nicholas Nissen MD

  3. Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Joanne Rutgers MD, Deepti Dhall MD & Shefali Chopra MD

  4. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Jason Naziri BS & Richard Tuli MD, PhD

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  1. Arsen Osipov MD
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Correspondence to Richard Tuli MD, PhD.

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Osipov, A., Nissen, N., Rutgers, J. et al. Redefining the Positive Margin in Pancreatic Cancer: Impact on Patterns of Failure, Long-Term Survival and Adjuvant Therapy. Ann Surg Oncol 24, 3674–3682 (2017). https://doi.org/10.1245/s10434-017-6076-z

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  • DOI: https://doi.org/10.1245/s10434-017-6076-z

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