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IMPACT OF SURGICAL MARGIN CLEARANCE ON PATTERNS OF RECURRENCE FOR PANCREATIC ADENOCARCINOMA
William P. Lancaster*, Thomas Maatman, Eugene P. Ceppa, Christian Schmidt, Nicholas J. Zyromski, Attila Nakeeb, Michael G. House
Surgery, Indiana University, Indianapolis, IN
Introduction
Retroperitoneal margin clearance for cancer of the pancreatic head is not amenable to surgical control. Traditionally, microscopically negative specimen margins are associated with the best prognosis in pancreatic cancer. The purpose of this study was to determine the associations between retroperitoneal margin clearance, survival, and patterns of recurrence after pancreatoduodenectomy for pancreatic cancer.
Methods
A prospectively maintained database of patients undergoing pancreatoduodenectomy at a high volume pancreatic surgery center was reviewed. Patients were included if final pathology demonstrated pancreatic adenocarcinoma. Patients were classified according to the radial width of retroperitoneal margin clearance (R1, <1mm, 1-10mm, >10mm) determined by experienced pancreatic pathologists.
Results
A total of 215 consecutive patients from June 2010 to December 2013 were included in the analysis. The median follow-up for the entire cohort was 20 mos. Among patients with R1 retroperitoneal margin, the median disease-free survival (DFS) was 18 mos. Retroperitoneal margin clearance of <1mm, 1-10mm, and >10mm was not associated with improved DFS (median DFS 15, 22, 18 mos respectively[M6] , p=0.5), see graph. No patients with R1 or <1mm margin status were free of recurrence at 3 yrs whereas 5-yr DFS for the 1-10mm and >10mm groups was 20% and 37%, respectively. The predominant site of recurrence in all groups was distant (liver, lung, peritoneum) compared to locoregional; R1 75%, <1mm 67%, 1-10mm 71%, >10mm 77 %, p=1.
Conclusion
The degree of retroperitoneal margin clearance is not associated with disease-free survival or patterns of disease recurrence after pancreatoduodenectomy for pancreatic cancer. Positive or narrow retroperitoneal margins represent surrogate markers for unfavorable cancer biology associated with early disease progression.
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