Clinical significance of revised microscopic positive resection margin status in ductal adenocarcinoma of pancreatic head

Abstract Background: To identify preoperative computed tomography radiomics texture features which correlate with resection margin status and prognosis in resected pancreatic head adenocarcinoma. Methods: Improved prognostication methods utilizing novel non-invasive radiomic techniques may accurately predict resection margin status preoperatively. In an ongoing concerning pancreatic head adenocarcinoma, the venous enhanced CT images of 86 patients who underwent pancreaticoduodenectomy were selected, and the resection margin (>1 mm or ≤1 mm) was identified by pathological examination. Three regions of interests (ROIs) were then taken from superior to inferior facing the superior mesenteric vein and artery. Subsequent Laplacian-Dirichlet based texture analysis methods extracting algorithm flows of texture features within ROIs were analyzed and assessed in relation to patient prognosis.Results: Patients with >1 mm resection margin had an overall improved survival compared to ≤1 mm (P < 0.05). Distance 1 and 2 of Gray level co-occurrence matrix, high Gray-level run emphasis of run-length matrix and average filter of wavelet transform (all P < 0.05) were correlated with resection margin status (Area under the curve was 0.784, sensitivity was 75% and specificity was 79%). The energy of wavelet transform, the measure of smoothness of histogram and the variance in 2 direction of Gabor transform are independent predictors of overall survival prognosis, independent of resection margin.Conclusions: Resection margin status (>1 mm vs ≤1 mm) is a key prognostic factor in pancreatic adenocarcinoma and CT radiomic analysis have the potential to predict resection margin status preoperatively, and the radiomic labels may improve selection neoadjucant therapy. Trial registration: Clinicaltrials.gov/ct2/show/NCT02928081.

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Influence of standardized histopathological workup on reporting of the resection margin status in pancreatic head cancer

The Egyptian Journal of Surgery ◽

10.4103/1110-1121.141894 ◽

2014 ◽

Vol 33 (3) ◽

pp. 131

Author(s):

AhmedM El-Gendi ◽

Saba El-Gendi

Keyword(s):

Resection Margin ◽

Pancreatic Head ◽

Margin Status ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Resection Margin Status ◽

Histopathological Workup

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Prospective assessment of resection margin status following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma after standardisation of margin definitions

Pancreatology ◽

10.1016/j.pan.2020.01.004 ◽

2020 ◽

Vol 20 (3) ◽

pp. 537-544 ◽

Cited By ~ 3

Author(s):

J.K. Pine ◽

B. Haugk ◽

S.M. Robinson ◽

A. Darne ◽

C. Wilson ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Resection Margin ◽

Margin Status ◽

Ductal Adenocarcinoma ◽

Prospective Assessment ◽

Resection Margin Status

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Preoperative Chemotherapy and Resection Margin Status in Colorectal Liver Metastasis Patients: A Propensity Score–Matched Analysis

The American Surgeon ◽

10.1177/000313481908500525 ◽

2019 ◽

Vol 85 (5) ◽

pp. 488-493

Author(s):

Leonardo Solaini ◽

Andrea Gardini ◽

Alessandro Passardi ◽

Maria Teresa Mirarchi ◽

Fabrizio D'Acapito ◽

...

Keyword(s):

Regression Analysis ◽

Liver Resection ◽

Liver Metastasis ◽

Propensity Score ◽

Preoperative Chemotherapy ◽

Resection Margin ◽

Margin Status ◽

Positive Resection Margin ◽

Resection Margin Status ◽

Surgery First

In this article, we compared the early and long-term outcomes of patients with metastatic colorectal cancer treated with chemotherapy followed by resection with those of patients undergoing surgery first, focusing our analysis on resection margin status. Patients who underwent liver resection with curative intent for colorectal liver metastases from July 2001 to January 2018 were included in the analysis. Propensity score matching was used to reduce treatment allocation bias. The cohort comprised 164 patients; 117 (71.3%) underwent liver resection first, whereas the remaining 47 (28.7%) had preoperative chemotherapy. After a 1:1 ratio of propensity score matching, 47 patients per group were evaluated. A positive resection margin was found in 13 patients in the surgery-first group (25.5%) versus 4 (8.5%) in the preoperative chemotherapy group ( P = 0.029). Postmatched logistic regression analysis showed that only preoperative chemotherapy was significantly associated with the rate of positive resection margin (odds ratio 0.24, 95% confidence interval 0.07–0.81; P = 0.022). Median follow-up was 41 months (interquartile range 8–69). Cox proportional hazard regression analysis revealed that only positive resection margin was a significant negative prognostic factor (hazard ratio 2.2, 95% CI 1.18–4.11; P = 0.014). Within the preoperative chemotherapy group, median overall survival was 40 months in R0 patients and 10 months in R1 patients ( P = 0.016). Although preoperative chemotherapy in colorectal liver metastasis patients may affect the rate of positive resection margin, its impact on survival seems to be limited. In the present study, the most important prognostic factor was the resection margin status.

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

Annals of Surgical Oncology ◽

10.1245/s10434-021-10464-6 ◽

2021 ◽

Author(s):

Mushegh A. Sahakyan ◽

Caroline S. Verbeke ◽

Tore Tholfsen ◽

Dejan Ignjatovic ◽

Dyre Kleive ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Resection Margin ◽

Margin Status ◽

Ductal Adenocarcinoma ◽

Resection Margins ◽

Prognostic Impact ◽

Entire Cohort ◽

Period 2 ◽

Node Ratio ◽

Resection Margin Status

Abstract Background Resection margin status is considered one of the few surgeon-controlled parameters affecting prognosis in pancreatic ductal adenocarcinoma (PDAC). While studies mostly focus on resection margins in pancreatoduodenectomy, little is known about their role in distal pancreatectomy (DP). This study aimed to investigate resection margins in DP for PDAC. Methods Patients who underwent DP for PDAC between October 2004 and February 2020 were included (n = 124). Resection margins and associated parameters were studied in two consecutive time periods during which different pathology examination protocols were used: non-standardized (period 1: 2004–2014) and standardized (period 2: 2015–2020). Microscopic margin involvement (R1) was defined as ≤1 mm clearance. Results Laparoscopic and open resections were performed in 117 (94.4%) and 7 (5.6%) patients, respectively. The R1 rate for the entire cohort was 73.4%, increasing from 60.4% in period 1 to 83.1% in period 2 (p = 0.005). A significantly higher R1 rate was observed for the posterior margin (35.8 vs. 70.4%, p < 0.001) and anterior pancreatic surface (based on a 0 mm clearance; 18.9 vs. 35.4%, p = 0.045). Pathology examination period, poorly differentiated PDAC, and vascular invasion were associated with R1 in the multivariable model. Extended DP, positive anterior pancreatic surface, lymph node ratio, perineural invasion, and adjuvant chemotherapy, but not R1, were significant prognostic factors for overall survival in the entire cohort. Conclusions Pathology examination is a key determinant of resection margin status following DP for PDAC. A high R1 rate is to be expected when pathology examination is meticulous and standardized. Involvement of the anterior pancreatic surface affects prognosis.

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