Prognostic Value of Resection Margin Involvement After Pancreaticoduodenectomy for Ductal Adenocarcinoma

Delpero, Jean‐Robert; Jeune, Florence Le; Bachellier, Philippe; Régenet, Nicolas; Treut, Yves Patrice Le; Paye, François; Carrère, Nicolas; Sauvanet, Alain; Adham, Mustapha; Autret, A.; Poizat, Flora; Turrini, Olivıer; Boher, Jean-Marie

doi:10.1097/sla.0000000000002432

Cited by 84 publications

(99 citation statements)

References 45 publications

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“…Survival also depends on the topography of the positive resection margin (patients with anterior/posterior (+) margins have longer survival than of patients with medial (+) margins) . Contrariwise other studies found that the R1 resection was not a predictor of overall or disease‐free survival and the R1 resection less than 1 mm was relevant in certain subgroups . There is increased evidence that neoadjuvant therapy helps increase R0 resection.…”

Section: Discussionmentioning

confidence: 99%

“…19 Contrariwise other studies found that the R1 resection was not a predictor of overall or disease-free survival 18,23,24 and the R1 resection less than 1 mm was relevant in certain subgroups. 25 There is increased evidence that neoadjuvant therapy helps increase R0 resection. In a meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable and borederline resectable pancreas cancer (BRPC), the R0 resection rate was significantly higher in patients who had neoadjuvant treatment (86·8% vs 66·9%).…”

Section: Discussionmentioning

confidence: 99%

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Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients

Alexakis

Bramis

Toutouzas

et al. 2019

Journal of Surgical Oncology

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Background/Aim Anatomic vascular abnormalities of the hepatic arteries are frequent. The aim of the study was to analyze the influence of hepatic arterial variations on postoperative morbidity and resection margin status after pancreatoduodenectomy (PD). Materials/Methods Patients who underwent PD over a 7‐year period (2010‐2017) were included in the study. Patients with variant hepatic arterial anatomy were matched 1:2 for age, sex, ASA score, and histology. Results A total of 232 patients underwent PD. Variant hepatic arterial anatomy was found in 35 (15.1% of the total patient population). The most common variation was an accessory right hepatic artery (8.19%) and a replaced right hepatic artery (5.60%) arising from the superior mesenteric artery. These 35 patients were compared with 70 patients with no hepatic artery variations. Postoperative surgical complications occurred in 12.1% and 26.5% (P = 0.08) and in‐hospital mortality was 6% and 5.4% ( P = 0.99) between patients with and without variant hepatic arteries. There was no difference in positive resection margins (R1) (18.2% vs 20.5%, P = 0.99) between the two groups. Conclusions An aberrant hepatic artery does not increase morbidity or R1 resection in patients undergoing PD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients

Alexakis

Bramis

Toutouzas

et al. 2019

Journal of Surgical Oncology

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“…However, the effect of positive RM remains controversial. Recently, in a French multicenter study, Delpero et al found that a margin clearance < 1 mm was associated with poor progression‐free survival and OS only in the univariate analysis. The impact of this factor was outweighed by nodal involvement on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

Panaro

Kellil

Vendrell

et al. 2019

Journal of Surgical Oncology

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Background Microvascular invasion (MVI) has been proved to be poor prognostic factor in many cancers. To date, only one study published highlights the relationship between this factor and the natural history of pancreatic cancer. The aim of this study was to assess the impact of MVI, on disease‐free survival (DFS) and overall survival (OS), after pancreatico‐duodenectomy (PD) for pancreatic head adenocarcinoma. Secondarily, we aim to demonstrate that MVI is the most important factor to predict OS after surgery compared with resection margin (RM) and lymph node (LN) status. Materials and Methods Between January 2015 and December 2017, 158 PD were performed in two hepato‐bilio‐pancreatic (HBP) centers. Among these, only 79 patients fulfilled the inclusion criteria of the study. Clinical‐pathological data and outcomes were retrospectively analyzed from a prospectively maintained database. Results Of the 79 patients in the cohort, MVI was identified in 35 (44.3%). In univariate analysis, MVI (P = .012 and P < .0001), RM (P = .023 and P = .021), and LN status (P < .0001 and P = .0001) were significantly associated with DFS and OS. A less than 1 mm margin clearance did not influence relapse (P = .72) or long‐term survival (P = .48). LN ratio > 0.226 had a negative impact on OS (P = .044). In multivariate analysis, MVI and RM persisted as independent prognostic factors of DFS (P = .0075 and P = .0098, respectively) and OS (P < .0001 and P = .0194, respectively). Using the likelihood ratio test, MVI was identified as the best fit to predict OS after PD for ductal adenocarcinomas compared with the margin status model (R0 vs R1) (P = .0014). Conclusion The MVI represents another major prognostic factor determining long‐term outcomes.

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“…Therefore, identification of novel methods that can effectively inhibit PCa cell growth and metastasis is urgently needed. Targeted therapies have shown promise in achieving these goals [19][20][21]. ZFX, also known as ZNF926, is a sex chromosome gene [21].…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic cancer (PCa) is the most lethal solid tumour and is the fourth leading cause of cancer-related death, with an overall 5-year survival rate of <5% [1,2]. Due to local invasion, early metastasis, and resistance to standard chemotherapy, the median survival time of PCa patients is only 5-8 months despite recent advances in surgical techniques and medical management [3,4].…”

Section: Introductionmentioning

confidence: 99%

ZFX Promotes Proliferation and Metastasis of Pancreatic Cancer Cells via the MAPK Pathway

Song

Zhu

Zhang

et al. 2018

Cell Physiol Biochem

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Background/Aims: The role of ZFX in tumourigenesis is unclear. We aimed to study ZFX expression, regulation, and function and the clinical implications of this protein in human pancreatic cancer (PCa). Methods: One hundred and twenty patients with histologically confirmed PCa who underwent surgery were recruited for this study. Tumour samples and PCa cell lines were used to examine ZFX. Various cell functions related to tumourigenesis were assessed. In vivo mouse tumour xenografts were used to confirm the in vitro results. Results: Patients with ZFX-positive tumours had worse overall survival than patients with ZFX-negative tumours. The depletion of ZFX using lentiviral shRNAs significantly inhibited cell proliferation by inducing cell cycle arrest in G0/G1 phase and resulted in increased cell apoptosis and invasive repression. In vivo studies confirmed that ZFX promoted tumour growth. Mechanistically, MAPK pathway activation was involved in the oncogenic functions of ZFX. Conclusions: ZFX acts as a putative oncogene in PCa and could be a novel therapeutic target for this disease.

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Prognostic Value of Resection Margin Involvement After Pancreaticoduodenectomy for Ductal Adenocarcinoma

Abstract: ClinicalTrials.gov: NCT00918853.

Cited by 84 publications

References 45 publications

Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients

Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients

Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

ZFX Promotes Proliferation and Metastasis of Pancreatic Cancer Cells via the MAPK Pathway

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