Resection margin involvement and tumour origin in pancreatic head cancer

Abstract

Inaccurate and inconsistent distinction between pancreatic, ampullary and distal bile duct cancer, combined with inaccuracies in resection margin assessment, results in obfuscation of key clinicopathological data. Specimen dissection technique plays a key role in the quality of the assessment of both tumour origin and margin status. Unless the pathological examination is meticulous and standardized, comparison of results between centres and observations in multicentre trials will remain of limited value.

Is There a ‘Margin’ for Error in Pancreatic Cancer Surgery?

“…Gnerlich et al examined four margins, for which we assume that the: n Pancreatic neck margin refers to the transection margin. This margin is reported in the literature to be positive in <10% of cases [4] as it is examined by frozen section intraoperatively, and in this study it was involved in 7.7% (22/285) of all resections [1]. Moreover, it may have been unnecessary to include 20 of the 22 patients with R1 pancreatic neck margins in the analysis, as these cases were clearly dealt with by proceeding to total pancreatectomy, and therefore no pancreas was left in situ.…”

“…Moreover, it may have been unnecessary to include 20 of the 22 patients with R1 pancreatic neck margins in the analysis, as these cases were clearly dealt with by proceeding to total pancreatectomy, and therefore no pancreas was left in situ. Removing these patients, and therefore this covariate, may have strengthened the subsequent findings in the multivariate analysis; refers to the surface facing the superior mesenteric artery (SMA), which has also been referred to in the literature as the medial margin [4][5][6] or the medial transection plane when dividing the lymphovascular tissue of the mesopancreas [ Thus, without information on exactly which constituents of the circumferential resection margin (CRM) are involved, it is difficult to fully appreciate the results of this study. This lack of international consensus has resulted in a disparity in the R1 status of the posterior and medial margins reported in the literature varying from 44 to 64% and 38 to 69% of R1 resections, respectively [4].…”

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

“…Our study confirms that patients with PMC and r1 resection have significantly worsened median OS, which could suggest an interaction between immunological insults from PMC and bad biology as reflected in r1 resections. The rate of r1 resections has been reported to range from as low as 18% to as high as 85% in patients undergoing SF approach in pancreatic cancer, whereas recent reports show r0 resection rates in patients with PDaC treated with a variety of neoadjuvant chemotherapy or chemoradiation protocols followed by surgery in the range 72-95%, indicating a beneficial effect of the NT strategy on margin status [36,37]. The correlations between PMC and histopathological determinants of long-term survival, such as resection margins and lymph node status, should be subjects of further research in SF and NT patients.…”

A Standardized Light-Emitting Diode Device for Photoimmunotherapy

“…Antibody-based photodynamic therapy-that is, photoimmunotherapy (PIT)-can be an ideal modality to improve cancer treatment because of its inherent selectivity for targeting tumors. The application can be used for both initial treatment and eliminating residual microscopic disease during incomplete resection, which is common, for instance, in pancreatic cancer (;75% positive margins) and in locally advanced rectal cancer (;35% positive margins) (3,4). PIT uses a nontoxic light-sensitive compound (i.e., a photosensitizer) bound to a tumor-targeting antibody, which can serve as both a diagnostic and a therapeutic agent (5).…”