Prognostic factors for survival after extended pancreatectomy for pancreatic head cancer: influence of resection margin status on survival.
OBJECTIVE
Although a positive resection margin has been reported to be a strong prognostic factor after resection for pancreatic cancer, several studies indicated that resection status did not independently affect survival. The aim of this study was to examine the influence of resection margin status on survival after extended radical resection for pancreatic head cancer.


METHODS
One hundred thirty-eight cases of pancreatoduodenectomy and 38 cases of pylorus-preserving pancreatoduodenectomy for invasive ductal carcinoma of the pancreas were retrospectively analyzed.


RESULTS
The resection margins were negative (R0) in 115 patients (65.3%), microscopically positive (R1) in 38 patients (21.6%), and grossly positive (R2) in 23 patients (13.1%). Patients with R1 resection survived significantly shorter (median survival time [MST], 9.4 months) than R0 resection patients (MST, 15.2 months) but survived longer than R2 resection patients (MST, 6.2 months). By multivariate analysis, R2 resection, together with lymph node metastasis, portal venous system, and extrapancreatic nerve plexus invasions, independently affected the overall survival, but R1 resection was not significantly influential.


CONCLUSIONS
R2 resection was an independent predictor of poor prognosis after pancreatoduodenectomy/pylorus-preserving pancreatoduodenectomy, whereas R1 resection did not independently affect the survival.
Kato
Koichi
K
Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan. katokon@med.nagoya-u.ac.jp
Yamada
Suguru
S
Sugimoto
Hiroyuki
H
Kanazumi
Naohito
N
Nomoto
Shuji
S
Takeda
Shin
S
Kodera
Yasuhiro
Y
Morita
Satoshi
S
Nakao
Akimasa
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies