Synapse - Detailed analysis of margin positivity and the site of local recurrence after pancreaticoduodenectomy

Detailed analysis of margin positivity and the site of local recurrence after pancreaticoduodenectomy Journal Article

Authors:	McIntyre, C. A.; Zambirinis, C. P.; Pulvirenti, A.; Chou, J. F.; Gonen, M.; Balachandran, V. P.; Kingham, T. P.; D’Angelica, M. I.; Brennan, M. F.; Drebin, J. A.; Jarnagin, W. R.; Allen, P. J.
Article Title:	Detailed analysis of margin positivity and the site of local recurrence after pancreaticoduodenectomy
Abstract:	Background: The association between a positive surgical margin and local recurrence after resection of pancreatic adenocarcinoma (PDAC) has been reported. Assessment of the location of the a positive margin and the specific site of local recurrence has not been well described. Methods: A prospectively maintained database was queried for patients who underwent R0/R1 pancreaticoduodenectomy for PDAC between 2000 and 2015. The pancreatic, posterior, gastric/duodenal, anterior peritoneal, and bile duct margins were routinely assessed. Postoperative imaging was reviewed for the site of first recurrence, and local recurrence was defined as recurrence located in the remnant pancreas, surgical bed, or retroperitoneal site outside the surgical bed. Results: During the study period, 891 patients underwent pancreaticoduodenectomy, and 390 patients had an initial local recurrence with or without distant metastases. The 5-year cumulative incidence of local recurrence by site included the remnant pancreas (4%; 95% confidence interval [CI], 3–5%), the surgical bed (35%; 95% CI, 32–39%), and other regional retroperitoneal site (4%; 95% CI, 3–6%). In the univariate analysis, positive posterior margin (hazard ratio [HR], 1.50; 95% CI, 1.17–1.91; p = 0.001) and positive lymph nodes (HR, 1.36; 95% CI, 1.06–1.75; p = 0.017) were associated with surgical bed recurrence, and in the multivariate analysis, positive posterior margin remained significant (HR, 1.40; 95% CI, 1.09–1.81; p = 0.009). An isolated local recurrence was found in 197 patients, and a positive posterior margin was associated with surgical bed recurrence in this subgroup (HR, 1.51; 95% CI, 1.08–2.10; p = 0.016). Conclusion: In this study, the primary association between site of margin positivity and site of local recurrence was between the posterior margin and surgical bed recurrence. Given this association and the limited ability to modify this margin intraoperatively, preoperative assessment should be emphasized. © 2020, Society of Surgical Oncology.
Journal Title:	Annals of Surgical Oncology
Volume:	28
Issue:	1
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2021-01-01
Start Page:	539
End Page:	549
Language:	English
DOI:	10.1245/s10434-020-08600-9
PUBMED:	32451945
PROVIDER:	scopus
PMCID:	PMC7918294
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85085508186&doi=10.1245%2fs10434-020-08600-9&partnerID=40&md5=993cad633b47466e6baf0d923785e4ea
Notes:	Article -- Export Date: 4 January 2021 -- Source: Scopus