Clinicopathologic study of intrapancreatic cancer spread in carcinoma of the body and tail of the pancreas.
OBJECTIVE
The aims of this study were to clarify the type of intrapancreatic spread of cancer of the pancreatic body and tail and to assess whether a 2-cm transection margin is adequate to ensure negative margins.


METHODS
We selected 66 patients who underwent distal pancreatectomy for cancer of the pancreatic body and tail. We investigated intrapancreatic cancer spread in these patients histopathologically and analyzed the relationship between 2-cm-margin positivity and other clinicopathological characteristics.


RESULTS
Two-centimeter-margin positivity was observed in 17 cases. In these, tumors had a tendency to spread toward the pancreatic head along the main pancreatic duct. As a result of statistical analysis, we considered venous invasion (odds ratio [OR], 15.48; 95% confidence interval [CI], 1.61-148.94; P = 0.0177), 2-cm-margin fibrosis (OR, 173.88; 95% CI, 8.96-3375.03; P = 0.0007), and 2-cm-margin hardness (OR, 5.97; 95% CI, 1.07-33.46; P = 0.0420) as being independently related to 2-cm-margin positivity.


CONCLUSIONS
The results suggest that 2 cm is not a safe length to ensure a negative margin. In the future, preoperative and intraoperative evaluation of the degree of fibrosis of pancreatic parenchyma could lead to cancer-free pancreatic cut-end margins.
Departments of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kazuo
K
Yamamura
Akimasa
A
Nakao
Tsutomu
T
Fujii
Suguru
S
Yamada
Hiroyuki
H
Sugimoto
Hideki
H
Kasuya
Shuji
S
Nomoto
Yasuhiro
Y
Kodera
Shigeo
S
Nakamura
Satoshi
S
Morita
Shin
S
Takeda
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery