Redefining the R1 resection in pancreatic cancer

Verbeke, Caroline S.; Leitch, Derek; Menon, Krishna; McMahon, M. J.; Guillou, Pierre J.; Anthoney, Alan

doi:10.1002/bjs.5397

Cited by 521 publications

(504 citation statements)

References 18 publications

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“…However, from an anatomical point of view, this nomenclature is controversial 24. The dissected margin of plPh‐II is reported to be the most favorable positive margin site for PDAC of the pancreatic head 3, 4, 5, 6. Therefore, complete clearance of the connective tissue around the SMA during PD is considered to increase R0 rate and improve the survival rate of patients with PDAC located in the pancreatic head 8, 9, 10, 12, 13, 21, 22, 23, 25.…”

Section: Discussionmentioning

confidence: 99%

“…Pathological positive margins of resected specimens (R1) could be found not only in BR‐PDAC but also in R‐PDAC, and might lead to early recurrence and poor survival. Dissected margins around the superior mesenteric artery (SMA) have been specifically reported to be the most favorable R1 site for PDAC located in the pancreatic head 3, 4, 5, 6…”

Section: Introductionmentioning

confidence: 99%

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Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

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Mesenteric approach is an artery‐first approach during pancreaticoduodenectomy (PD). In the present study, we evaluated clinical and oncological benefits of this procedure for pancreatic ductal adenocarcinoma (PDAC) of the pancreas head. Between 2000 and 2015, 237 consecutive PDAC patients underwent PD. Among them, 72 experienced the mesenteric approach (mesenteric group) and 165 the conventional approach (conventional group). A matched‐pairs group consisted of 116 patients (58 patients in each group) matched for age, gender, resectability status, and neoadjuvant therapy. Surgical and oncological outcomes were compared between the two groups in unmatched‐ and matched‐pair analyses. Intraoperative blood loss was lower in the mesenteric group than in the conventional group in both resectable PDAC (R‐PDAC) and borderline resectable PDAC (BR‐PDAC) on unmatched‐ and matched‐pairs analyses (R‐PDAC, unmatched: 312.5 vs 510 mL, P=.008; matched: 312.5 vs 501.5 mL, P=.023; BR‐PDAC, unmatched: 507.5 vs 935 mL, P<.001; matched: 507.5 vs 920 mL, P=.003). Negative surgical margins (R0) and overall survival (OS) rates in the mesenteric group were better in R‐PDAC patients (R0 rates, unmatched: 100% vs 87.7%, P=.044; matched: 100% vs 86.7%, P=.045; OS, unmatched: P=.008, matched: P=.021), although there were no significant differences in BR‐PDAC patients. Mesenteric approach might reduce blood loss by early ligation of the vessels to the pancreatic head. Furthermore, it might increase R0 rate, leading to improvement of survival for R‐PDAC patients. However, R0 and survival rates could not be improved only by the mesenteric approach for BR‐PDAC patients. Therefore, effective multidisciplinary treatment is essential to improve survival in BR‐PDAC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

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“…Nowadays, we know that oncologic surgery of the head of the pancreas is feasible in the presence of a variant hepatic artery (5). Arterial variant involves a technical difficulty that may determine a more conservative resection of the pancreas, especially for retropancreatic plane and lead an inadequate removal of the tumor (9). By contrast, a more aggressive surgery that tries to keep this variant may increase the operating time, greater blood loss postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the type of resection, we used the criteria of the American Joint Commission on Cancer Staging Manual (6 th edition) once performed the pathological anatomical study (8). We considered R0 the absence of tumor cells in all resection margins; R1 if tumor cells were detected less than 1 mm from the resection margin; R2 if there were evidence of macroscopic tumor (9). Tumor resection margins studied were: Section of the distal bile duct, retroportal plane and the edge of pancreatic section.…”

Section: Methodsmentioning

confidence: 99%

Implication of the presence of a variant hepatic artery during the Whipple procedure

Rubio-Manzanares-Dorado¹,

Marín-Gómez²,

Aparicio-Sánchez³

et al. 2015

Rev Esp Enferm Dig

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Introduction:The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD) in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods:We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results:We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%). The most frequent variant was an aberrant right hepatic artery (n = 7), following by the accessory right hepatic artery (n = 2) and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2). In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications.Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

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“…Until 2007 the pathologist reported a margin positive (r1) only if tumour cells were present at the surface (clearance equals 0 mm). From 2008 the definition was consistently changed to a 1 mm clearance [16]. Measurement of serum Ca 19-9 was not mandatory prior to surgery.…”

Section: Patient Characteristics and Operationsmentioning

confidence: 99%

Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma – A population-based cohort study

et al. 2015

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Gladhaug (2016) Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma -A population-based cohort study, Acta Oncologica, 55:3,[265][266][267][268][269][270][271][272][273][274][275][276][277] DOI: 10.3109 conclusions. MMT completion is strongly associated with reduced mortality risk in patients with resectable PDAC undergoing the SF approach. Early disease progression and PMC/poor performance status preclude MMT completion in more than one third of the patients. These reasons for failure to complete MMT underscore the need for strategies to improve patient selection and reduce surgical morbidity in patients with resectable PDAC.

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Redefining the R1 resection in pancreatic cancer

Abstract: Standardized examination influences the reporting of RM status.

Cited by 521 publications

References 18 publications

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Implication of the presence of a variant hepatic artery during the Whipple procedure

Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma – A population-based cohort study

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