RT Journal
A1 Gnerlich JL, Luka SR, Deshpande AD, et al
T1 MIcroscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD August 1
VO 147
IS 8
SP 753
OP 760
DO 10.1001/archsurg.2012.1126
UL http://dx.doi.org/10.1001/archsurg.2012.1126
AB Objective 
                  To correlate microscopic margin status with survival and local control in a large cohort of patients from a high-volume pancreatic cancer center.Design 
                  Retrospective database review. A uniform procedure for margin analysis was used with 4-color inking (neck, portal vein groove, uncinate, and posterior pancreatic margin) by the surgeon in the operating room.Setting 
                  A tertiary care hospital.Patients 
                  We reviewed patients who underwent pancreaticoduodenectomy between September 1, 1997, and December 31, 2008, from a prospective, institutional database.Main Outcome Measures 
                  Using Cox regression models, we identified pathologic characteristics associated with local recurrence (LR) after controlling for potential confounding variables. Overall and LR-free survival curves were generated by the Kaplan-Meier method.Results 
                  Of 285 patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma, 97 (34.0%) had 1 or more positive microscopic margins (uncinate, 16.5%; portal vein groove, 8.8%; neck, 7.7%; and posterior, 10.5%). A total of 198 patients (69.5%) recurred, with the first site of failure being LR only in 47 (23.7%), local plus distant recurrence in 42 (21.2%), and distant recurrence only in 109 (55.1%). Patients with LR only were significantly more likely to have lymph node involvement (adjusted hazard ratio, 2.66; 95% CI, 1.25-5.63) or a positive posterior margin (adjusted hazard ratio, 4.27; 95% CI, 2.07-8.81). Patients with a positive posterior margin had significantly poorer LR-free survival with (P < .001) or without (P = .01) lymph node involvement.Conclusions 
                  When systematically assessed, the incidence of positive microscopic margins is high. Positive posterior margins and lymph node involvement were each independently and significantly associated with LR.