Pancreaticoduodenal resection for carcinoma head of pancreas – the influence of margin status on survival

Abstract

Aim: To evaluate the influence of margin status on survival following resection for carcinoma head of pancreas (CaHOP). Methods: A retrospective analysis of prospectively maintained database of patients undergoing a Pancreaticoduodenal resection (PDR) for CaHOP. 547 patients underwent a PDR at a tertiary care center from Jan 2001 till Dec 2013. Of these, 24 patients (4.4%) operated for CaHOP form the study material. Margins were defined as macroscopically positive (R2), microscopically positive (R1), negative margins (R0) and close margins which were less than 1mm (Rc). Results: 13/24 (54.2%) patients were R0, 6/24 (25%) were R1, 3/24 (12.5%) were Rc. 2 (8.3%) patients had positive margins on intra-operative frozen section and underwent a total pancreaticoduodenectomy (TPD). 1 (4.2%) patient expired postoperatively following a classical PD . The postoperative morbidity included post pancreaticoduodenectomy hemorrhage (PPH)(n=3, 12.5%), pancreaticojejunostomy (PJ) leak (n=5, 22.7%), bile leak (n=2,8.3%) and DGE (n=4,16.7%) The overall survival of these patients was 15.3 months. The survival following R0 resection was 15.5 months, 13.9 months for R1 and Rc resection and 20 months for TPD. Patients undergoing TPD for positive intraoperative margin on frozen section had better survival than those with R1 or close surgical (Rc) margins (20 months vs 13.9 months) though there was no statistically significant difference based on margin status of the patients because of small group size. Conclusion: R1 and Rc resections fare similarly. TPD for positive resection margins provides better overall survival with acceptable morbidity. Larger prospective trials are required to validate these results.