The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas

Abstract

The prognosis of ductal adenocarcinoma of the pancreas is still poor. We analysed the factors that have a major influence on the survival of patients. Surgical specimens from 51 patients with ductal adenocarcinoma of the head of the pancreas were examined for tumour size, histological type, grade and local extension. In 7 patients the retroperitoneal resection margin was involved either macroscopically or histologically. Their mean survival was 10.6 months (1-17 months), compared with 22.7 months for the 44 patients with curative R0 resection. In 10 patients large vessels (portal and/or mesenteric vein) had to be resected; they survived for only 2-11 months, with a mean of 5 months (P<0.05). Non-R0-resected patients and patients in whom tumour-invaded vessels had to be resected constitute a high-risk group with a significantly shorter mean survival of 8.8 months, compared with 24.3 months for R0 resected patients without vessel invasion (P<0.05). Lymph node metastases were seen in 35 of 51 patients. Survival analysis based on nodal status revealed a mean survival of 33 months for patients staged as N0, 21.4 for N1a patients and 14 month for N1b patients. The differences were not statistically significant, however. Our data suggest that tumour invasion of the retroperitoneal resection margin and large vessel involvement are the major factors determining survival in patients with pancreatic cancer.

The K-ras mutation pattern in pancreatic ductal adenocarcinoma usually is identical to that in associated normal, hyperplastic, and metaplastic ductal epithelium

“…Surgical specimens from 35 patients (mean age of 68 years; range, 48-75 years) of a series of 51 patients 15 who underwent partial duodenopancreatectomy for ductal adenocarcinoma of the head of the pancreas were selected for the investigation. The basis for selection was the availability of suitable paraffin blocks (i.e., blocks age Ͻ 5 years).…”

Recommendation for the Examination of Pancreaticoduodenectomy Specimens Removed from Patients with Carcinoma of the Exocrine Pancreas

“…Our recommendation for a standardized processing of resection specimens for pancreatic carcinomas is based on our earlier recommendations [19, 20]and on recent extensive experience with several series that ultimately included 80 duodenopancreatectomy specimens [3, 21, 22]. Most of the cases in these series were sectioned immediately in the operation theatre in close cooperation and communication with the surgeons.…”

Preliminary experience with the hanging maneuver for pancreaticoduodenectomy

“…6 head of the pancreas all the retroperitoneal peripancreatic tissue, anterior to the inferior vena cava and the left renal vein, in order to increase the number of R0 resections to extend the circumferential resection margins [4,7,14].…”

“…Malignant periampullary tumours often invade the retroperitoneal peripancreatic tissues and microscopic positive resection margin (R1 resection) following PD is associated with a poor survival [3,4]. The retroperitoneal margin is the most frequently invaded, resulting in R1 resection of PD in about 20% [3,5].…”

“…The retroperitoneal margin is the most frequently invaded, resulting in R1 resection of PD in about 20% [3,5]. The retroperitoneal peripancreatic tissue surrounds the first 3 to 4 cm of the superior mesenteric artery (SMA) origin behind the superior mesenteric vein (SMV) [3][4][5][6][7]. Recently Gockel et al [8] has defined this anatomical structure as "mesopancreas" similarly to the mesorectum.…”