Aims and objectives
Pancreatic adenocarcinoma is a disease with a poor prognosis,
mainly due to its late clinical presentation and limited response to chemo- and radiotherapy.
Currently,
surgical resection followed by adjuvant therapy represents the only potentially curative treatment for localized disease,
increasing the 5-year overall survival from less than 5% to 10-20% [1-3].
Many prognostic factors have been identified in predicting long-term survival,
like tumor stage,
differentiation,
nodal involvement,
preoperative levels of CA 19-9,
type of resection and adjuvant therapy [3-5].
The impact of microscopic margin involvement...
Methods and materials
Patient population: we considered for inclusion 68 patients who underwent follow-up CT after resection for pancreatic adenocarcinoma between July 2009 and December 2014.
All patients underwent post-operative adjuvant chemo- and radiotherapy.
Inclusion criteria were: presence of one CT with findings suggestive for local or distant recurrence of disease,
availability of at least one subsequent contrast-enhanced examination and/or seriated serum levels of CA 19-9 (43/68).
Our study population finally included 43 patients,
22 males and 21 females with a mean age of 66,6 years (range 40...
Results
33 tumors were located in the head,
10 in the body or in the tail.
Mean and median intervals between surgery and recurrence at CT were respectively 458 and 337 days for the patients who had R0 resection (range 51 – 1907) and 242 and 205 days for R1-2 resection (range 44 – 536) (p=0.0737).
31 patients underwent pancreaticoduodenectomy,
10 patients underwent spleno-pancreasectomy and 2 patients underwent total pancreasectomy.
31 patients had a R0 resection (72%),
11 patients had a R1 resection (26%) and 1...
Conclusion
In oncology,
a positive surgical margin is generally accepted as a poor prognostic factor,
even though its impact on the overall and disease-free survival in pancreatic adenocarcinoma is controversial [5-7].
Our study focused on the relationship existing between resection margin status and pattern of recurrence detected at CT.
The two major patterns were local recurrence and metastatic disease,
alone or in association with one another.
Despite R+ resections should theoretically be correlated with higher rates of local recurrence,
in our series there were no differences...
References
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Sankila R,
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54(3):385-387.
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Jang JY,
Kim SW,
Kim WH,
Lee KU,
Park YH: Analysis of long-term survivors after surgical resection for pancreatic cancer.
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3. Cleary SP,
Gryfe R,
Guindi M,
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Smith L,
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Langer B et al: Prognostic...