title: A systematic review of the role of periadventitial dissection of the superior mesenteric artery in affecting margin status after pancreatoduodenectomy for pancreatic adenocarcinoma.
abstract: BACKGROUND
  Resectable pancreatic ductal adenocarcinoma continues to carry a poor prognosis. Of the controllable clinical variables known to affect outcome, margin status is paramount. Though the importance of a R0 resection is generally accepted, not all margins are easily managed. The superior mesenteric artery [SMA] in particular is the most challenging to clear. The aim of this study was to systematically review the literature with specific focus on the role of a SMA periadventitial dissection during PD and it's effect on margin status in pancreatic adenocarcinoma.
  
  
  METHODS
  The MEDLINE, EMBASE and Cochrane databases were searched for abstracts that addressed the effect of margin status on survival and recurrence following pancreaticoduodenectomy [PD]. Quantitative analysis was performed.
  
  
  RESULTS
  The overall incidence of a R1 resection ranged from 16% to 79%. The margin that was most often positive following PD was the SMA margin, which was positive in 15-45% of resected specimens. Most studies suggested that a positive margin was associated with decreased survival. No consistent definition of R0 resection was observed.
  
  
  CONCLUSIONS
  Margin positivity in resectable pancreatic adenocarcinoma is associated with poor survival. Inability to clear the SMA margin is the most common cause of incomplete resection. More complete and consistently reported data are needed to evaluate the potential effect of periadventitial SMA dissection on margin status, local recurrence, or survival.
authors.affiliation: Indiana University School of Medicine, Department of Surgery, Indianapolis IN, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Butler
authors.affiliation: The University of Cincinnati Cancer Institute, Cincinnati OH, USA.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Katz
authors.affiliation: Indiana University School of Medicine, Department of Surgery, Indianapolis IN, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Cioffi
authors.affiliation: Indiana University School of Medicine, Department of Surgery, Indianapolis IN, USA. Electronic address: nzyromsk@iupui.edu.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004210:Dissection / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome