Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4186-4195
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4186
Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma
Cheng-Gang Li, Zhi-Peng Zhou, Xiang-Long Tan, Yuan-Xing Gao, Zi-Zheng Wang, Qu Liu, Zhi-Ming Zhao
Cheng-Gang Li, Zhi-Peng Zhou, Xiang-Long Tan, Yuan-Xing Gao, Zi-Zheng Wang, Qu Liu, Zhi-Ming Zhao, Second Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
Author contributions: Li CG and Zhou ZP contributed equally to this work, and considered as co-first authors; Li CG and Zhou ZP analyzed and interpreted data and wrote the article; Tan XL, Gao YX, Wang ZZ and Liu Q drafted the work and collected the data; Zhao ZM designed the study and revised the articles for important intellectual content.
Institutional review board statement: The study was approved by the Institutional Review Board of the Chinese People's Liberation Army General Hospital (S2016-098-02).
Informed consent statement: Informed consent was signed by all patients in the study.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Data sharing statement: Due to the sensitive nature of the questions asked in this study, survey respondents were assured raw data would remain confidential and would not be shared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Ming Zhao, MD, PhD, Associate Professor, Second Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China. zhimingzhao616@126.com
Telephone: +86-10-66937584 Fax: +86-10-66937584
Received: September 5, 2019
Peer-review started: September 5, 2019
First decision: October 24, 2019
Revised: October 31, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: December 26, 2019
Abstract
BACKGROUND

The impact of resection margin status on long-term survival after pancreaticoduodenectomy (PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.

METHODS

Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.

RESULTS

Among the 124 patients, R0 resection was achieved in 85 patients (68.5%), R1 resection in 38 patients (30.7%) and R2 resection in 1 patient (0.8%). The 1- and 3-year overall survival (OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection (1-year OS rates: 69.4% vs 53.0%; 3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.

CONCLUSION

Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

Keywords: Pancreatic head cancer, Pancreaticoduodenectomy, R0 resection margin, Overall survival, Disease-free survival, R1 resection

Core tip: This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after pancreaticoduodenectomy using the tumor node metastasis standard. We found the resection margin was an independent risk factor for overall survival for patients with pancreatic head carcinoma after pancreaticoduodenectomy. R0 resection was associated with significantly better overall survival after surgery. It is suggested that surgeons should perform radical resection for patients with pancreatic head cancer as much as possible.