title: Mesopancreatic Stromal Clearance Defines Curative Resection of Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters: A Retrospective Study.
abstract: Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability.Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011.Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status.Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability.
authors.affiliation: From the Clinic for Surgery, UKSH Campus Lübeck, Lübeck (UFW, HL, LB, DB, TK); Clinic for Radiology (TK, ML); Institute of Pathology (AC, ST, MW, PB); Clinic for General and Visceral Surgery, University Medical Center Freiburg (BK, JH, SK, GS, FM, UTH); Institute for Molecular Medicine and Cell Research, University of Freiburg, Freiburg (OS); Department of Surgery, University Hospital Hamburg-Eppendorf (UKE), Hamburg (YKV); Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Heidelberg (TB); Comprehensive Cancer Center Freiburg, Freiburg (ML, FM, UTH, MW, PB); and German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (OS, MW, PB).
authors.forename: Ulrich F
authors.initials: UF
authors.lastname: Wellner
authors.forename: Tobias
authors.initials: T
authors.lastname: Krauss
authors.forename: Agnes
authors.initials: A
authors.lastname: Csanadi
authors.forename: Hryhoriy
authors.initials: H
authors.lastname: Lapshyn
authors.forename: Louisa
authors.initials: L
authors.lastname: Bolm
authors.forename: Sylvia
authors.initials: S
authors.lastname: Timme
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
authors.forename: Simon
authors.initials: S
authors.lastname: Kuesters
authors.forename: Gabriel
authors.initials: G
authors.lastname: Seifert
authors.forename: Dirk
authors.initials: D
authors.lastname: Bausch
authors.forename: Oliver
authors.initials: O
authors.lastname: Schilling
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.forename: Peter
authors.initials: P
authors.lastname: Bronsert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D017154:Stromal Cells / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
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