title: Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma.
abstract: In patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC), conversion to total pancreatectomy (TP) may be necessary to achieve R0 resection.
  
  
  OBJECTIVE
  We sought to examine the oncologic benefit of conversion of PD to TP to achieve an R0 resection in patients with an isolated positive neck margin.
  
  
  METHODS
  We conducted a retrospective analysis of prospectively collected data at Indiana University and Johns Hopkins Medical Institutions. A review of 1,579 patients who underwent PD or TP for PC at these institutions between 1992 and 2006 was performed. Sixty-one patients were eligible.
  
  
  RESULTS
  Twenty-eight patients underwent PD with an isolated positive neck margin found on pathologic examination; 33 patients had conversion to TP for isolated neck margin involvement to achieve R0 resection. Patients undergoing TP versus PD had a greater median survival (18 vs 10 months; P = .04). Mortality (6% vs 7%) and morbidity (36% vs 54%; P = .20) for TP versus PD were comparable. Multivariate analysis revealed PD and greater tumor size as the only independent predictors of poor long-term survival (hazard ratio [HR], 2.2; P = .01 and HR, 1.3; P = .005).
  
  
  CONCLUSIONS
  Conversion of PD to TP to achieve an R0 resection in patients with pancreatic adenocarcinoma is associated with a survival benefit.
authors.affiliation: Department of Surgery and Indiana University Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA. maxschmi@iupui.edu
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Glant
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Winter
authors.forename: Jason
authors.initials: J
authors.lastname: Kennard
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dixon
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhao
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
authors.forename: Atilla
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000379:methods / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies