Affiliation:
1. Pompeu Fabra University
2. Hospital Del Mar
Abstract
Abstract
PURPOSE: Pancreatic ductal adenocarcinoma (PADC) still has
nowadays a very impaired long-term survival. Most studies are
focused on overall survival, however local recurrence occurs about
20% of cases and seems to be highly related with margin resection
status and therefore with surgical performance. We aim to analyze
the impact of vascular resection margins on local recurrence (LR)
and to assess its impact on overall and disease-free survival.
METHODS: Eighty out of 191 patients who underwent
pancreatoduodenectomy in a university Hospital between 2006 and
2021 with PDAC diagnosis were analyzed and vascular margin status
specifically addressed. Univariate and multivariate were performed.
Time to LR was compared by using the Kaplan-Meier method and
prognostic factors assessed using Cox regression hazards
model.
RESULTS: LR appeared in 10 (50%) of the overall R1 resections
in the venous margin and 9 (60%) in the arterial one. Time to LR
was significantly shorter when any margin was overall affected
(23.2 vs 44.7 months, p=0.01) and specifically in the arterial
margin involvement (13.7 vs 32.1 months, p=0.009). Overall R1
resections (HR: 2.61, p=0.013) and a positive arterial margin (HR:
2.84, p=0.012) were associated with local recurrence on univariate
analysis, whereas arterial positive margin remained significant on
multivariate analysis (HR: 2.70, p=0.031).
CONCLUSIONS: Arterial margin invasion is correlated in our
cohort with local recurrence. Given the limited ability to modify
this margin intraoperatively, preoperative therapies should be
considered to improve local margin clearance.
Publisher
Research Square Platform LLC