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©The Author(s) 2019.
World J Clin Cases. Dec 26, 2019; 7(24): 4186-4195
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4186
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4186
Table 1 Patient demographics
Clinicopathologic features | Value |
Mean age (range), yr | 59 (38-79) |
Sex, M/F | 76/48 |
Histopathologic diagnosis | |
Well differentiated | 1 |
Moderately differentiated | 74 |
Poorly differentiated | 49 |
Adenocarcinoma | 118 |
Adenocarcinoma + mucinouscarcinoma | 5 |
Adenosquamous carcinoma | 1 |
Stage (Union International Contre le Cancer, 8th ed) | |
I | 59 |
II | 57 |
III | 7 |
IV | 1 |
Resection margin status | |
R0 | 85 |
R1 | 38 |
R2 | 1 |
Median overall survival (range) in mo | 16 (7-66) |
Table 2 Factors associated with microscopically positive resection margin (R2 resection was excluded)
No. patients | P value | ||
R0 | R1 | ||
Total patients | 85 | 38 | |
Age in yr | 0.192 | ||
≥ 60 | 47 | 22 | |
< 60 | 39 | 15 | |
Sex | 0.719 | ||
M | 53 | 23 | |
F | 33 | 14 | |
Tumor size in cm | 1.000 | ||
< 2 | 6 | 3 | |
≥ 2 | 80 | 34 | |
Bile duct invasion | 0.486 | ||
Negative | 28 | 15 | |
Positive | 58 | 23 | |
Duodenal invasion | 0.480 | ||
Negative | 40 | 12 | |
Positive | 46 | 25 | |
Nerve plexus invasion | 0.848 | ||
Negative | 36 | 13 | |
Positive | 50 | 24 | |
Lymph node metastasis | 0.562 | ||
Negative | 54 | 21 | |
Positive | 32 | 16 | |
Venous invasion | 0.435 | ||
Negative | 79 | 32 | |
Positive | 7 | 5 | |
Postoperative chemotherapy | 0.180 | ||
No | 45 | 25 | |
Yes | 41 | 12 | |
Postoperative radiotherapy | 0.354 | ||
No | 67 | 44 | |
Yes | 18 | 4 | |
Operation blood loss in mL | 251.61 ± 173.94 | 299.23 ± 216.67 | 0.195 |
Hospital stay in d | 16.70 ± 7.98 | 16.31 ± 5.65 | 0.786 |
Table 3 Median survival of patients who underwent pancreaticoduodenectomy for pancreatic head adenocarcinoma (R2 resection was excluded)
Prognostic variables | Univariate | Multivariate | ||||
HR | 95%CI | P value | HR | 95%CI | P value | |
Age in yr | ||||||
≥ 60 | 1.000 | - | 0.218 | |||
< 60 | 0.770 | 0.508-1.167 | ||||
Sex | ||||||
M | 1.000 | - | 0.959 | |||
F | 0.995 | 0.807-1.226 | ||||
Tumor size in cm | ||||||
≥ 2 | 1.000 | - | 0.140 | |||
< 2 | 0.507 | 0.206-1.251 | ||||
Differentiation degree | ||||||
Poor | 1.000 | 0.791 | ||||
Well + Middle | 0.944 | 0.619-1.442 | ||||
Margin status | ||||||
R0 | 1.000 | - | 0.0101 | 1.000 | 0.0331 | |
R1 | 1.773 | 1.149-2.736 | 1.632 | 1.041-2.529 | ||
Bile duct invasion | ||||||
Negative | 1.000 | - | 0.654 | |||
Positive | 1.100 | 0.724-1.677 | ||||
Duodenal invasion | ||||||
Negative | 1.000 | - | 0.415 | |||
Positive | 1.188 | 0.785-1.796 | ||||
Nerve plexus invasion | ||||||
Negative | 1.000 | - | 0.484 | |||
Positive | 1.159 | 0.766-1.754 | ||||
Lymph node metastasis | ||||||
Negative | 1.000 | - | 0.238 | |||
Positive | 1.285 | 0.847-1.947 | ||||
Venous invasion | ||||||
Negative | 1.000 | - | 0.0021 | 1.000 | 0.0101 | |
Positive | 2.771 | 1.447-5.304 | 2.395 | 1.237-4.636 | ||
Postop. chemotherapy | 0.427 | |||||
No | 1.000 | - | ||||
Yes | 0.846 | 0.561-1.277 | ||||
Postop. radiotherapy | 0.944 | |||||
No | 1.000 | - | ||||
Yes | 1.018 | 0.624-1.660 | ||||
Op. blood loss (100 mL) | 1.001. | 1.000-1.002 | 0.081 | |||
Postop. hospital stay | 1.026 | 0.999-1.054 | 0.057 |
Table 4 Summary of studies evaluating the impact of margin status on survival
Ref. | R1/R2 patients, n (%) | Resection status | Median R1/R2 survival in mo | Median R0 survival in mo |
Podda et al[19], 2017 | 34 (36) | R1 | 18 | 26 |
Sugiura et al[20], 2013 | 40 (19) | R1 | 23 | 30 |
Petermann et al[13], 2013 | 36 (38) | R1 | 14 | 19 |
Zhang et al[14], 2012 | 48 (57) | R1 | 17 | 29 |
Rau et al[21], 2012 | 56 (44) | R1 | 14 | 19 |
Fatima et al[22], 2010 | 149 (24) | R1/R2 | 15/10 | 19 |
Kato et al[4], 2009 | 61 (35) | R1/R2 | 9/6 | 15 |
Raut et al[5], 2007 | 60 (17) | R1 | 22 | 28 |
Present study | 38 (31) | R1 | 16 | 23 |
- Citation: Li CG, Zhou ZP, Tan XL, Gao YX, Wang ZZ, Liu Q, Zhao ZM. Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma. World J Clin Cases 2019; 7(24): 4186-4195
- URL: https://www.wjgnet.com/2307-8960/full/v7/i24/4186.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v7.i24.4186