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.
| Original language | English |
|---|---|
| Article number | e2529 |
| Journal | Medicine (United States) |
| Volume | 95 |
| Issue number | 3 |
| ISSN | 0025-7974 |
| DOIs | |
| Publication status | Published - 01.01.2016 |
Funding
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 Editor: Wenfu Tang. Received: August 12, 2015; revised: December 1, 2015; accepted: December 21, 2015. 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). Correspondence: Ulrich F. Wellner, Klinik für Chirurgie, UKSH Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany (e-mail: [email protected]). UFW and T Krauss contributed equally to this work. This study was supported by a research grant to UFW by the German Research Council (DFG WE5085/1-1). MW and TK received funding from the German Research Council (SFB850/B2, SFB850/C5, SFB992C06). Supplemental Digital Content is available for this article. The authors have no conflicts of interest to disclose. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000002529
Research Areas and Centers
- Research Area: Luebeck Integrated Oncology Network (LION)
