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Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis

BACKGROUND: The present study aimed to examine the impact of microscopically tumour-infiltrated resection margins (R1) in pancreatic ductal adenocarcinoma (PDAC) patients with advanced lymphonodular metastasis (pN1–pN2) on overall survival (OS). METHODS: This retrospective, multi-institutional analy...

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Autores principales: Teske, Christian, Stimpel, Richard, Distler, Marius, Merkel, Susanne, Grützmann, Robert, Bolm, Louisa, Wellner, Ulrich, Keck, Tobias, Aust, Daniela E., Weitz, Jürgen, Welsch, Thilo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370927/
https://www.ncbi.nlm.nih.gov/pubmed/33712875
http://dx.doi.org/10.1007/s00423-021-02138-4
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author Teske, Christian
Stimpel, Richard
Distler, Marius
Merkel, Susanne
Grützmann, Robert
Bolm, Louisa
Wellner, Ulrich
Keck, Tobias
Aust, Daniela E.
Weitz, Jürgen
Welsch, Thilo
author_facet Teske, Christian
Stimpel, Richard
Distler, Marius
Merkel, Susanne
Grützmann, Robert
Bolm, Louisa
Wellner, Ulrich
Keck, Tobias
Aust, Daniela E.
Weitz, Jürgen
Welsch, Thilo
author_sort Teske, Christian
collection PubMed
description BACKGROUND: The present study aimed to examine the impact of microscopically tumour-infiltrated resection margins (R1) in pancreatic ductal adenocarcinoma (PDAC) patients with advanced lymphonodular metastasis (pN1–pN2) on overall survival (OS). METHODS: This retrospective, multi-institutional analysis included patients undergoing surgical resection for PDAC at three tertiary university centres between 2005 and 2018. Subcohorts of patients with lymph node status pN0–N2 were stratified according to the histopathological resection status using Kaplan-Meier survival analysis. RESULTS: The OS of the entire cohort (n = 620) correlated inversely with the pN status (26 [pN0], 18 [pN1], 11.8 [pN2] months, P < 0.001) and R status (21.7 [R0], 12.5 [R1] months, P < 0.001). However, there was no statistically significant OS difference between R0 versus R1 in cases with advanced lymphonodular metastases: 19.6 months (95% CI: 17.4–20.9) versus 13.6 months (95% CI: 10.7–18.0) for pN1 stage and 13.7 months (95% CI: 10.7–18.9) versus 10.1 months (95% CI: 7.9–19.1) for pN2, respectively. Accordingly, N stage–dependent Cox regression analysis revealed that R status was a prognostic factor in pN0 cases only. Furthermore, there was no significant survival disadvantage for patients with R0 resection but circumferential resection margin invasion (≤ 1 mm; CRM+; 10.7 months) versus CRM-negative (13.7 months) cases in pN2 stages (P = 0.5). CONCLUSIONS: An R1 resection is not associated with worse OS in pN2 cases. If there is evidence of advanced lymph node metastasis and a re-resection due to an R1 situation (e.g. at venous or arterial vessels) may substantially increase the perioperative risk, margin clearance in order to reach local control might be avoided with respect to the OS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-021-02138-4.
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spelling pubmed-83709272021-08-31 Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis Teske, Christian Stimpel, Richard Distler, Marius Merkel, Susanne Grützmann, Robert Bolm, Louisa Wellner, Ulrich Keck, Tobias Aust, Daniela E. Weitz, Jürgen Welsch, Thilo Langenbecks Arch Surg Original Article BACKGROUND: The present study aimed to examine the impact of microscopically tumour-infiltrated resection margins (R1) in pancreatic ductal adenocarcinoma (PDAC) patients with advanced lymphonodular metastasis (pN1–pN2) on overall survival (OS). METHODS: This retrospective, multi-institutional analysis included patients undergoing surgical resection for PDAC at three tertiary university centres between 2005 and 2018. Subcohorts of patients with lymph node status pN0–N2 were stratified according to the histopathological resection status using Kaplan-Meier survival analysis. RESULTS: The OS of the entire cohort (n = 620) correlated inversely with the pN status (26 [pN0], 18 [pN1], 11.8 [pN2] months, P < 0.001) and R status (21.7 [R0], 12.5 [R1] months, P < 0.001). However, there was no statistically significant OS difference between R0 versus R1 in cases with advanced lymphonodular metastases: 19.6 months (95% CI: 17.4–20.9) versus 13.6 months (95% CI: 10.7–18.0) for pN1 stage and 13.7 months (95% CI: 10.7–18.9) versus 10.1 months (95% CI: 7.9–19.1) for pN2, respectively. Accordingly, N stage–dependent Cox regression analysis revealed that R status was a prognostic factor in pN0 cases only. Furthermore, there was no significant survival disadvantage for patients with R0 resection but circumferential resection margin invasion (≤ 1 mm; CRM+; 10.7 months) versus CRM-negative (13.7 months) cases in pN2 stages (P = 0.5). CONCLUSIONS: An R1 resection is not associated with worse OS in pN2 cases. If there is evidence of advanced lymph node metastasis and a re-resection due to an R1 situation (e.g. at venous or arterial vessels) may substantially increase the perioperative risk, margin clearance in order to reach local control might be avoided with respect to the OS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-021-02138-4. Springer Berlin Heidelberg 2021-03-13 2021 /pmc/articles/PMC8370927/ /pubmed/33712875 http://dx.doi.org/10.1007/s00423-021-02138-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Teske, Christian
Stimpel, Richard
Distler, Marius
Merkel, Susanne
Grützmann, Robert
Bolm, Louisa
Wellner, Ulrich
Keck, Tobias
Aust, Daniela E.
Weitz, Jürgen
Welsch, Thilo
Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis
title Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis
title_full Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis
title_fullStr Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis
title_full_unstemmed Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis
title_short Impact of resection margin status on survival in advanced N stage pancreatic cancer – a multi-institutional analysis
title_sort impact of resection margin status on survival in advanced n stage pancreatic cancer – a multi-institutional analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370927/
https://www.ncbi.nlm.nih.gov/pubmed/33712875
http://dx.doi.org/10.1007/s00423-021-02138-4
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