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
ARTICLE HIGHLIGHTS
Research background

In recent years, the status of resection margin of patients with pancreatic head carcinoma after pancreaticoduodenectomy (PD) has received much attention, but controversies still exist.

Research motivation

This study aimed to examine the impact of resection margin status on long-term overall survival (OS) of patients with pancreatic head carcinoma after PD.

Research objectives

This study examined the impact of resection margin status on long-term OS of patients with pancreatic head carcinoma after PD by the tumor node metastasis standard.

Research 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 OS was retrospectively analyzed.

Research 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 OS rates were significantly higher for the patients who underwent R0 resection than 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 resection margin status and venous invasion to be significant risk factors of OS. Future studies should be required to determine the impact of resection margin status on long-term OS of patients with pancreatic head carcinoma after PD in a larger sample population.

Research conclusions

This study suggested that patients with R0 resection had significantly better postoperative long-term OS than those with R1 resection. Venous invasion was an independent factor influencing survival. Adequate resection to achieve R0 resection can improve postoperative long-term OS for patients with pancreatic head cancer.

Research perspectives

The sample size of this study was small and patients who died of complications in the perioperative period were not included because this study focused only on long-term OS. The follow-up isolation time was also too long in this study, which would affect the accuracy of OS. Future studies will be required to determine the impact of resection margin status on long-term OS of patients with pancreatic head carcinoma after PD in larger sample population.