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. 2012:2012:513241.
doi: 10.5402/2012/513241. Epub 2012 Jun 18.

Locally advanced pancreatic head cancer: margin-positive resection or bypass?

Ulrich Friedrich Wellner  1 , Frank Makowiec, Dirk Bausch, Jens Höppner, Olivia Sick, Ulrich Theodor Hopt, Tobias Keck
Affiliations

Locally advanced pancreatic head cancer: margin-positive resection or bypass?

Ulrich Friedrich Wellner et al. ISRN Surg. 2012.

Abstract

Pancreatic cancer is a highly aggressive disease with poor survival. The only effective therapy offering long-term survival is complete surgical resection. In the setting of nonmetastatic disease, locally advanced tumors constitute a technical challenge to the surgeon and may result in margin-positive resection margins. Few studies have evaluated the implications of the latter in depth. The aim of this study was to compare the margin-positive situation to palliative bypass procedures and margin-negative resections in terms of perioperative and long-term outcome. By retrospective analysis of prospectively maintained data from 360 patients operated for pancreatic cancer at our institution, we provide evidence that margin-positive resection still yields a significant survival benefit over palliative bypass procedures. At the same time, perioperative severe morbidity and mortality are not significantly increased. Our observations suggest that pancreatic cancer should be resected whenever technically feasible, including, cases of locally advanced disease.

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Figures

Figure 1
Figure 1
Survival after R1 resection. Kaplan-Meier Survival Function Plot. Asterisk denotes  P < 0.05  for Logrank test versus the control group BYP M0. BYP: palliative bypass procedure, M0: absence of distant metastasis at laparotomy, R0/R1: pancreatoduodenectomy with free/microscopically positive resection margins.
Figure 2
Figure 2
Survival after Pancreatoduodenectomy for Locally Advanced Tumors with Portal Venous Resection. Kaplan-Meier Survival Function Plot. Asterisk denotes  P < 0.05  for Logrank test versus the control group BYP M0. BYP: palliative bypass procedure, M0: absence of distant metastasis at laparotomy, and PVR: portal venous resection.
Figure 3
Figure 3
Survival after R2 resection and in metastatic pancreatic cancer. Kaplan-Meier Survival Function Plot. Asterisk denotes  P < 0.05  for Logrank test versus the control group BYP M0. BYP: palliative bypass procedure, M0/M+: absence/presence of distant metastasis at laparotomy, R0/R2: pancreatoduodenectomy with free/macroscopically positive resection margins.
Figure 4
Figure 4
Flow scheme for the surgical treatment of pancreatic cancer. M0/M+: absence/presence of distant metastasis at laparotomy, R0/R2: pancreatoduodenectomy with free/macroscopically positive resection margins. Figures given from the present study.
See this image and copyright information in PMC

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