Margin Clearance and Outcome in Resected Pancreatic Cancer

Author:

Chang David K.1,Johns Amber L.1,Merrett Neil D.1,Gill Anthony J.1,Colvin Emily K.1,Scarlett Christopher J.1,Nguyen Nam Q.1,Leong Rupert W.L.1,Cosman Peter H.1,Kelly Mark I.1,Sutherland Robert L.1,Henshall Susan M.1,Kench James G.1,Biankin Andrew V.1

Affiliation:

1. Cancer Research Program, Garvan Institute of Medical Research, Sydney; Departments of Surgery and Gastroenterology, Bankstown Hospital, University of New South Wales, Bankstown; Department of Anatomical Pathology, Royal North Shore Hospital, University of Sydney, St Leonards; Department of Surgery, Liverpool Hospital, Liverpool; and Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Abstract

Purpose Current adjuvant therapies for pancreatic cancer (PC) are inconsistently used and only modestly effective. Because a high proportion of patients who undergo resection for PC likely harbor occult metastatic disease, any adjuvant trials assessing therapies such as radiotherapy directed at locoregional disease are significantly underpowered. Stratification based on the probability (and volume) of residual locoregional disease could play an important role in the design of future clinical trials assessing adjuvant radiotherapy. Patients and Methods We assessed the relationships between margin involvement, the proximity to operative resection margins and outcome in a cohort of 365 patients who underwent operative resection for PC. Results Microscopic involvement of a resection margin by tumor was associated with a poor prognosis. Stratifying the minimum clearance of resection margins by 0.5-mm increments demonstrated that although median survival was no different to clear margins based on these definitions, it was not until the resection margin was clear by more than 1.5 mm that optimal long-term survival was achieved. Conclusion These data demonstrate that a margin clearance of more than 1.5 mm is important for long-term survival in a subgroup of patients. More aggressive therapeutic approaches that target locoregional disease such as radiotherapy may be beneficial in patients with close surgical margins. Stratification of patients for entry onto future clinical trials based on this criterion may identify those patients who benefit from adjuvant radiotherapy.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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