Improvement in pathological reporting quality indexes for pancreatic ductal adenocarcinoma (PDAC) in a high volume surgical centre through definition of a standardized pathway in pathological examination of surgical specimen.

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) accounts for 90% of the pancreatic cancers. The incidence is around 10 cases/100.000 individuals with a similar mortality. Resection rate is around 15-20% and 5year survival around 20% of those with resected tumors. Aims: Evaluate angiolymphatic invasion (ALI) as a prognostic factor in resected N0 PDAC. Patients&methods: Retrospective analysis of 38 patients submitted to pancreaticoduodenectomy due to PDAC in a tertiary center. All specimens were analyzed with H&E stain. Tumor diameter, margins, lymph nodes, pTNM UICC, ALI, and perineural invasion were described in the pathology report. Statistical analisys considered p < 0,05 CI 95%. Results: 23 (60.5%) patients were female and 15 (39.5%) male. Mean age was 59 years. Overall survival was 22.3 months. 23 patients underwent gemcitabine based adjuvant chemotherapy or chemoradiation. There was no statistical significance between this group and the group with no adjuvant therapy (p 1⁄4 0,24). Patients with R0 ressection had significantly better survival compared with R1 ressection both in univariate and multivariate analisys (p < 0,001). 14 patients had ALI with N0 while 9 patients did not have ALI. There was no statistical significance in the number of lymphnode resection between these two groups (p 1⁄4 0,11), and survival was significantly better in the ALI-N0 group compared with the ALI+N0 group (p 1⁄4 0,021), considering T1-2-3 tumors. Conclusion: The present study shows that, even in a low-number casuistic, the angiolymphatic invasion in N0 duodenopancreatectomy can be evaluated by a cheap and easy method (H&E stain) and represents a poor prognosis factor for those patients. Abstracts / Pancreato