The impact of intraoperative pancreatic resection margin status on prognosis of patients with pancreatic head cancer / 中华肝胆外科杂志

ABSTRACT

Objective@#To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer.@*Methods@#The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively. The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model. Logistic multivariate analysis was used to study factors influencing the margin status.@*Results@#Of 109 patients, 20 had a positive intraoperative resection margin, and 89 had a negative margin. Postoperative pathological examination showed that all the patients had a negative surgical margin. Univariate analysis suggested that CA19-9 before operation, preoperative adjuvant chemotherapy, intraoperative pancreatic resection margin status, maximum diameter of tumor, perineural invasion, lymphovascular invasion, tumor differentiation, and N staging were significantly related to survival in the entire cohort (all P<0.05). Multivariate analysis showed CA19-9 ≥37 IU/ml, perineural invasion, lymph node metastasis, tumor diameter ≥4 cm and poor tumor differentiation were independent risk factors of bad prognosis (P<0.05). Univariate analysis of prognosis showed significant differences in lifetime prognosis between the positive margin group and the negative group (median survival time 11 months vs. 21 months, P<0.05), but a positive resection margin was not an independent risk factor on prognosis (P>0.05). Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group, the distribution of adverse pathologic factors like low tumor differentiation, tumor diameter ≥4 cm, perineural invasion and lymphovascular invasion were significantly different compared with the negative group (P<0.05). Tumor diameter ≥4 cm (OR=5.72, 95%CI 1.60~20.49) and low tumor differentiation (OR=3.79, 95%CI 1.20~11.95) were independent influencing factors of positive margin on logistic multivariate analysis.@*Conclusions@#Intraoperative pancreatic positive margin was not an independent risk factor of prognosis, but it was meaningful in predicting survival. Presence of positive margins was often combined with existence of some adverse pathological features, such as large tumor diameter and low tumor differentiation. Prognosis of patients with a positive margin was often poor. A positive pancreatic margin was an intraoperative marker of poor tumor biology in patients with pancreatic ductal adenocarcinoma.