TY - JOUR
T1 - Recurrence patterns of pancreatic cancer after pancreatoduodenectomy
T2 - systematic review and a single-centre retrospective study
AU - Kalisvaart, Marit
AU - Broadhurst, Damian
AU - Marcon, Francesca
AU - Pande, Rupaly
AU - Schlegel, Andrea
AU - Sutcliffe, Robert
AU - Marudanayagam, Ravi
AU - Mirza, Darius
AU - Chatzizacharias, Nikolaos
AU - Abradelo, Manuel
AU - Muiesan, Paolo
AU - Isaac, John
AU - Ma, Yuk T.
AU - Mcconville, Christopher
AU - Roberts, Keith
PY - 2020/2/8
Y1 - 2020/2/8
N2 - Background: Positive margins in pancreatoduodenectomy (PD) for pancreatic cancer, specifically the superior mesenteric artery (SMA) margin, are associated with worse outcomes. Local therapies targeting these margins could impact on recurrence. This study analysed recurrence-patterns to identify whether strategies to control local disease could have a meaningful impact. Methods: (I) Systematic review to define recurrence patterns and resection margin status. (II) Additional retrospective study of PD performed at our centre. Results: In the systematic review, 23/617 evaluated studies were included (n = 3815). Local recurrence was observed in 7–69%. SMA margin (6 studies) was positive in 15–35%. In the retrospective study (n = 204), local recurrence was more frequently observed with a positive SMA margin (66 vs.45%; p = 0.005). Furthermore, in a multivariate cox-proportional hazard model, only a positive SMA margin was associated with disease recurrence (HR 1.615; 95%CI 1.127–2.315; p = 0.009). Interestingly, median overall survival was 20 months and similar for patients who developed local only, metastases only or simultaneous recurrence (p = 0.124). Conclusion: Local recurrence of pancreatic cancer is common and associated with similar mortality rates as those who present with simultaneous or metastatic recurrence. Involvement of the SMA margin is an independent predictor for disease progression and should be the target of future adjuvant local therapies.
AB - Background: Positive margins in pancreatoduodenectomy (PD) for pancreatic cancer, specifically the superior mesenteric artery (SMA) margin, are associated with worse outcomes. Local therapies targeting these margins could impact on recurrence. This study analysed recurrence-patterns to identify whether strategies to control local disease could have a meaningful impact. Methods: (I) Systematic review to define recurrence patterns and resection margin status. (II) Additional retrospective study of PD performed at our centre. Results: In the systematic review, 23/617 evaluated studies were included (n = 3815). Local recurrence was observed in 7–69%. SMA margin (6 studies) was positive in 15–35%. In the retrospective study (n = 204), local recurrence was more frequently observed with a positive SMA margin (66 vs.45%; p = 0.005). Furthermore, in a multivariate cox-proportional hazard model, only a positive SMA margin was associated with disease recurrence (HR 1.615; 95%CI 1.127–2.315; p = 0.009). Interestingly, median overall survival was 20 months and similar for patients who developed local only, metastases only or simultaneous recurrence (p = 0.124). Conclusion: Local recurrence of pancreatic cancer is common and associated with similar mortality rates as those who present with simultaneous or metastatic recurrence. Involvement of the SMA margin is an independent predictor for disease progression and should be the target of future adjuvant local therapies.
UR - http://www.scopus.com/inward/record.url?scp=85079066108&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2020.01.005
DO - 10.1016/j.hpb.2020.01.005
M3 - Article
SN - 1365-182X
VL - 22
SP - 1240
EP - 1249
JO - HPB : the official journal of the International Hepato Pancreato Biliary Association
JF - HPB : the official journal of the International Hepato Pancreato Biliary Association
IS - 9
ER -
