Detailed Abstract
[Poster Presentation 12 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP PP 12-S1] Evaluating Prognostic Significance And Clinical Implications of Resection Margins in Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma
Go Won CHOI 1, Won-Gun YUN 1, Mirang LEE 1, Hye-Sol JUNG 1, Young Jae CHO 1, Youngmin HAN 1, Wooil KWON 1, Jin-Young JANG 1
1 Department of Surgery And Cancer Research Institute, Seoul National University Hospital, REPUBLIC OF KOREA
Background : Curative resection is a well-known prognostic factor in pancreatectomy. However, the role and definition of resection margins in distal pancreatectomy are controversial, compared to pancreatic head lesions. This study aimed to review the prognostic impact of two margin definitions (0 mm rule and 1 mm rule) and specific margin in distal pancreatectomy.
Methods : Between 2010 and 2018, 203 patients with pancreatic cancer who underwent distal pancreatectomy were enrolled. Patients were categorized into three groups based on the 0 mm and 1 mm rule: R0-wide margin (tumor-free margin ≥ 1 mm), R0-narrow margin (0 mm < tumor-free margin < 1 mm), and R1 margin (tumor-free margin = 0 mm). The specific margins were analyzed, including transection, anterior, and posterior about the prognostic impact.
Results : The patients with R0-wide margin had the best survival outcomes compared to those with R0-narrow or R1 margin (p < 0.001). In multivariate analyses, R1 margin (HR [95% CI], 2.11 [1.33 – 3.34]; p = 0.002), unlike R0-narrow margin 1.38 [0.89 – 2.14]; p = 0.149), was associated with shorter overall survival than R0-wide margin. In multivariate analyses with specific margin, posterior margin involvement emerged as a significant independent predictor for overall survival (1.83 [1.07 – 3.13]; p = 0.027).
Conclusions : Comparing with the 1 mm rule, the 0 mm rule appears to be more suitable for predicting patient outcomes. Achieving R0 resection for the posterior margin is crucial for prognosis. These findings suggest potential implications for neoadjuvant treatment and extended distal pancreatectomy for pancreatic body/tail cancer with retroperitoneal infiltration.
Methods : Between 2010 and 2018, 203 patients with pancreatic cancer who underwent distal pancreatectomy were enrolled. Patients were categorized into three groups based on the 0 mm and 1 mm rule: R0-wide margin (tumor-free margin ≥ 1 mm), R0-narrow margin (0 mm < tumor-free margin < 1 mm), and R1 margin (tumor-free margin = 0 mm). The specific margins were analyzed, including transection, anterior, and posterior about the prognostic impact.
Results : The patients with R0-wide margin had the best survival outcomes compared to those with R0-narrow or R1 margin (p < 0.001). In multivariate analyses, R1 margin (HR [95% CI], 2.11 [1.33 – 3.34]; p = 0.002), unlike R0-narrow margin 1.38 [0.89 – 2.14]; p = 0.149), was associated with shorter overall survival than R0-wide margin. In multivariate analyses with specific margin, posterior margin involvement emerged as a significant independent predictor for overall survival (1.83 [1.07 – 3.13]; p = 0.027).
Conclusions : Comparing with the 1 mm rule, the 0 mm rule appears to be more suitable for predicting patient outcomes. Achieving R0 resection for the posterior margin is crucial for prognosis. These findings suggest potential implications for neoadjuvant treatment and extended distal pancreatectomy for pancreatic body/tail cancer with retroperitoneal infiltration.
SESSION
Poster Presentation 12
Zone F 3/22/2024 2:50 PM - 3:40 PM