Detailed Abstract
[Poster Presentation 12 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP PP 12-S4] A Clinical Significance of Resection Margin Status And the Potential Role of Perioperative Radiotherapy in Patients with Pancreatic Ductal Adenocarcinoma
Won-Gun YUN 1, Wooil KWON 1, Hee Ju SOHN 2, Youngmin HAN 1, Yoon Soo CHAE 1, Hye-Sol JUNG 1, Young Jae CHO 1, Mirang LEE 1, Chang-Sup LIM 3, Yoo-Seok YOON 4, Jin-Young JANG 1
1 Department of Surgery And Cancer Research Institute, Seoul National University Hospital, REPUBLIC OF KOREA, 2 Department of Surgery, Chung-Ang University Gwangmyeong Hospital, REPUBLIC OF KOREA, 3 Department of Surgery, Seoul National University Boramae Medical Center, REPUBLIC OF KOREA, 4 Department of Surgery, Seoul National University Bundang Hospital, REPUBLIC OF KOREA
Background : To improve survival outcomes in pancreatic cancer, surgeons have focused on obtaining microscopically negative margin in performing pancreaticoduodenectomy and developing perioperative treatment strategies. However, the clinical meaning of resection margin status and perioperative radiotherapy is still unclear, especially in neoadjuvant chemotherapy settings.
Methods : Between 2014 and 2019, 307 pancreatic cancer patients underwent upfront pancreaticoduodenectomy and 97 underwent neoadjuvant chemotherapy followed by pancreaticoduodenectomy at three tertiary referral hospitals were included. Margin status was divided into a 3-tier system: R0-wide (tumor-free margin ≥ 1 mm), R0-narrow (margin < 1 mm), and R1 (margin = 0 mm).
Results : In upfront surgery settings, the groups can be arranged in descending order of 5-year overall survival rates as follows: R0-wide group (39.1%), R0-narrow group (25.6%), and R1 group (12.5%). In neoadjuvant chemotherapy settings, the groups can also be arranged in descending order of 5-year overall survival rates as follows: R0-wide group (52.2%), R0-narrow group (45.5%), and R1 group (8.3%). However, differences between R0-wide and R0-narrow groups did not reach statistical significance (P = 0.587), unlike upfront surgery settings. In multivariate analyses, concurrent chemo-radiotherapy after surgery was significantly associated with decreased risk of locoregional recurrence in both treatment settings.
Conclusions : We found that obtaining a wide margin (≥ 1 mm) could enhance prognosis in upfront surgery settings and obtaining only a narrow margin (> 0 mm) could be sufficient in neoadjuvant chemotherapy settings. Additionally, adjuvant radiotherapy could be considered especially in patients with margin involvement.
Methods : Between 2014 and 2019, 307 pancreatic cancer patients underwent upfront pancreaticoduodenectomy and 97 underwent neoadjuvant chemotherapy followed by pancreaticoduodenectomy at three tertiary referral hospitals were included. Margin status was divided into a 3-tier system: R0-wide (tumor-free margin ≥ 1 mm), R0-narrow (margin < 1 mm), and R1 (margin = 0 mm).
Results : In upfront surgery settings, the groups can be arranged in descending order of 5-year overall survival rates as follows: R0-wide group (39.1%), R0-narrow group (25.6%), and R1 group (12.5%). In neoadjuvant chemotherapy settings, the groups can also be arranged in descending order of 5-year overall survival rates as follows: R0-wide group (52.2%), R0-narrow group (45.5%), and R1 group (8.3%). However, differences between R0-wide and R0-narrow groups did not reach statistical significance (P = 0.587), unlike upfront surgery settings. In multivariate analyses, concurrent chemo-radiotherapy after surgery was significantly associated with decreased risk of locoregional recurrence in both treatment settings.
Conclusions : We found that obtaining a wide margin (≥ 1 mm) could enhance prognosis in upfront surgery settings and obtaining only a narrow margin (> 0 mm) could be sufficient in neoadjuvant chemotherapy settings. Additionally, adjuvant radiotherapy could be considered especially in patients with margin involvement.
SESSION
Poster Presentation 12
Zone F 3/22/2024 2:50 PM - 3:40 PM