Abstract

319 Background: The use of neoadjuvant therapy has been widely used for borderline resectable pancreatic cancer (BLRPC). Controversy exists on the definition of BLRPC, and because of this, we examined the association of vascular involvement and margin status in patients who had initial resection. Methods: Records of 137 patients who had surgery for resectable or BLRPC were collected. Included were radiologist grading of venous/arterial involvement based on preoperative imaging. For patients with both staging recorded, we categorized vascular involvement as none, arterial only, venous only, or both. We examined the association of vascular involvement and margin status using Chi-square tests, and logistic regression. Results: Of 137 patients, all underwent surgery first. 85% had a Whipple without vascular resection, and 13% with. Of 134 patients with Ishikawa staging, there were 63% stage I, 17% stage II, 11% stage III, and 9% stage IV. Of 96 patients with arterial staging, there were 74% stage i, 16% stage ii, and 10% stage iii. Of 93 patients with both Ishikawa and arterial staging recorded, 61% had no vascular involvement, 7% arterial, 14% venous, and 17% had both. Ishikawa stage I-IV was associated with a positive SMA margin, and was seen in 14%, 44%, 53%, and 58%, respectively (p < 0.001). However, for arterial staging the association was weaker, and for arterial stages i-iii, a positive SMA margin was seen in 20%, 40%, and 40%, respectively (p = 0.06). Therefore, Ishikawa staging was more predicative of arterial involvement. Higher Ishikawa staging was associated with increased positive SMV margins; 5%, 26%, 33%, respectively (p < 0.001), while preoperative arterial staging was not predictive (p = 0.63). In logistic regression for any positive margin, only venous staging was significant in predicting a positive margin. Conclusions: The use of imaging in predicting positive margins is more accurate when using a venous grading system as opposed to an arterial one. With a more standard approach of designating degree of vein involvement, and better preoperative imaging, further studies will be needed to substantiate these findings.

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