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Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma

Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment option with curative intent, most patients die of locoregional and/or distant recurrence. The prognostic impact of the resection margin status has received much attention. However, the evidence is a...

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Autores principales: Holm, Maia Blomhoff, Verbeke, Caroline Sophie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9498008/
https://www.ncbi.nlm.nih.gov/pubmed/36135084
http://dx.doi.org/10.3390/curroncol29090515
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author Holm, Maia Blomhoff
Verbeke, Caroline Sophie
author_facet Holm, Maia Blomhoff
Verbeke, Caroline Sophie
author_sort Holm, Maia Blomhoff
collection PubMed
description Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment option with curative intent, most patients die of locoregional and/or distant recurrence. The prognostic impact of the resection margin status has received much attention. However, the evidence is almost exclusively related to pancreatoduodenectomies, while corresponding data for distal pancreatectomy specimens are limited. The key data, such as the rate of microscopic margin involvement (“R1”), the site of margin involvement, and the impact of R1 on patient outcome, are divergent between studies and do not currently allow any general conclusions. The main reasons for the variability in the published data are the small size of the study cohorts and their heterogeneity, as well as the marked divergence in pathology examination practices. The latter is a consequence of the lack of concrete guidance, both for grossing and microscopic examination. The increasing administration of neoadjuvant chemo(radio)therapy introduces a further factor of uncertainty as the conventional definition of a tumour-free margin (“R0”) based on 1 mm clearance is inadequate for these specimens. This review discusses the published data regarding the prognostic impact of margin status in distal pancreatectomy specimens along with the challenges and uncertainties that are related to the assessment of the margins.
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spelling pubmed-94980082022-09-23 Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma Holm, Maia Blomhoff Verbeke, Caroline Sophie Curr Oncol Review Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment option with curative intent, most patients die of locoregional and/or distant recurrence. The prognostic impact of the resection margin status has received much attention. However, the evidence is almost exclusively related to pancreatoduodenectomies, while corresponding data for distal pancreatectomy specimens are limited. The key data, such as the rate of microscopic margin involvement (“R1”), the site of margin involvement, and the impact of R1 on patient outcome, are divergent between studies and do not currently allow any general conclusions. The main reasons for the variability in the published data are the small size of the study cohorts and their heterogeneity, as well as the marked divergence in pathology examination practices. The latter is a consequence of the lack of concrete guidance, both for grossing and microscopic examination. The increasing administration of neoadjuvant chemo(radio)therapy introduces a further factor of uncertainty as the conventional definition of a tumour-free margin (“R0”) based on 1 mm clearance is inadequate for these specimens. This review discusses the published data regarding the prognostic impact of margin status in distal pancreatectomy specimens along with the challenges and uncertainties that are related to the assessment of the margins. MDPI 2022-09-14 /pmc/articles/PMC9498008/ /pubmed/36135084 http://dx.doi.org/10.3390/curroncol29090515 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Holm, Maia Blomhoff
Verbeke, Caroline Sophie
Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
title Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
title_full Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
title_fullStr Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
title_full_unstemmed Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
title_short Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
title_sort prognostic impact of resection margin status on distal pancreatectomy for ductal adenocarcinoma
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9498008/
https://www.ncbi.nlm.nih.gov/pubmed/36135084
http://dx.doi.org/10.3390/curroncol29090515
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