Pancreaticoduodenectomy For Pancreatic Adenocarcinoma Research Articles

Sulfonylureas (Not Metformin) Improve Survival for Patients with Diabetes and Resectable Pancreatic Adenocarcinoma

Objective: Patients with pancreatic adenocarcinoma have an increased propensity for diabetes. Recent studies suggest patients with diabetes and pancreatic adenocarcinoma treated with metformin have increased survival. This study was undertaken to determine if metformin use is associated with increased survival for patients with pancreatic adenocarcinoma. Methods: Patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma from 1991-2013 were included in this study. Survival was evaluated by Kaplan-Meier analysis. Median data are reported. Significance was accepted with 95% probability. Results: Out of 414 patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, 132 (32%) was diabetic. Of diabetic patients, 35 (27%) were diet-controlled, 34 (26%) were treated with insulin alone, 18 (14%) were treated with metformin alone, 14 (10%) were treated with sulfonylureas alone, 7 (5%) were taking sulfonylureas with insulin, and 24 (18%) patients were taking metformin with sulfonylureas and/or insulin. Patients with or without diabetes not taking sulfonylureas had survival of 16.4 months compared to patients taking sulfonylureas who achieved survival of 27.5 months after undergoing pancreaticoduodenectomy (p<0.05). Conclusion: Patients taking sulfonylureas with or without other therapy had improved survival compared to patients not taking sulfonylureas after pancreaticoduodenectomy. Metformin does not appear to be beneficial for patients with resectable disease, but may have a benefit for patients with unresectable and/or metastatic disease as shown in prior studies. The use of sulfonylureas is associated with a survival benefit for patients undergoing resection for pancreatic adenocarcinoma. Tumor staging and margin status continue to be the overriding predictors of survival for patients with resectable pancreatic adenocarcinoma, not metformin therapy.

Margin Status Impacts Survival after Pancreaticoduodenectomy but Negative Margins Should Not be Pursued

Negative margins are the goal with pancreaticoduodenectomy for pancreatic adenocarcinoma. Thereby, margins are assessed intraoperatively with frozen section analysis and negative margins are pursued. This study was undertaken to determine the impact of margin status with pancreaticoduodenectomy for pancreatic adenocarcinoma and the value of extending resections to achieve negative margins. The intraoperative frozen section analysis and final margins for 448 patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma were assessed and their impact on survival was determined. Median data are presented. Two hundred ninety-eight (67%) patients had negative margins (R0), an additional 110 (25%) patients had microscopically positive and macroscopically negative margins (R1), and an additional 40 (9%) patients had initially positive microscopic margins, which became negative with further resection (R1 → R0). R0 resections were more likely to have smaller tumors, earlier T grade, earlier N grade, lower American Joint Committee on Cancer stage, and less frequent extrapancreatic extension (P ≤ 0.03 for each). Survival was better with R0 resections than R1 resections (20 vs 12 months, P < 0.001); extending resections to achieve negative margins (i.e., R1 → R0) did not improve survival beyond R1 resections (14 vs 12 months, P = 0.19). Survival after pancreaticoduodenectomy is disappointing. Patients with initial negative margins do best. Positive microscopic margins reflect more aggressive tumor-specific factors and lead to abbreviated survival even with extended resections to achieve negative margins (i.e., R1 → R0). With an initial positive margin, pursuing negative margins does not improve survival and, thereby, negative margins should not be "chased."

Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility

The use of frozen section to assess resection margins intraoperatively during pancreaticoduodenectomy facilitates further resection. However, it is unclear whether this actually improves patient survival.We reviewed the overall survival and resection margin status in consecutive pancreaticoduodenectomies performed for carcinoma. An R1 resection was defined as an incomplete excision (≤1 mm margin); R0(p) resection as complete excision without re-resection and R0(s) resection as an initially positive neck margin which was converted to R0 resection after re-resection. Between 2007 and 2012, 116 pancreatoduodenectomies were performed for adenocarcinoma; 101 (87%) underwent frozen section of the neck margin which was positive in 19 (19%). Sixteen of these patients had negative neck margins after re-excision but only seven patients had no other involved margins [true R0(s) resections]. Median survival for the R0(p), R0(s) and R1 groups were 29, 16, 23 months, respectively (p = 0.049; R0(p) versus R0(s) p = 0.040). Intra-operative frozen section increased the overall R0 rate by 7% but this did not improve survival. Our findings question the clinical benefit of intraoperative margin assessment, particularly if re-excision cannot be performed easily and safely.

Aberrant right hepatic artery in pancreaticoduodenectomy for adenocarcinoma: impact on resectability and postoperative outcomes

ObjectivesAn aberrant right hepatic artery (aRHA) may pose technical and oncologic challenges during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA) as a result of its proximity to the head of the pancreas. The aim of this study was to assess the impact of an aRHA on resectability, and perioperative and oncologic outcomes after PD for PA. MethodsAn 11-year retrospective cohort study was conducted. A total of 289 patients with PA scheduled for PD with intent for resection were included in the study. ResultsOf 289 patients, 249 underwent PD and 40 were found to have unresectable tumours. Incidences of aRHA in the resectable (14.9%) and unresectable (7.5%) groups were similar (P = 0.2); the main reasons for aborting PD were not directly related to the presence of an aRHA. In patients who underwent resection, complications occurred more frequently in the standard PD group (41.5% versus 24.3%; P = 0.04), but there was no difference in rates of positive margin (R1) resection (10.8% versus 16.0%; P = 0.4) or median overall survival (17 months versus 23 months; P = 0.1) between patients with and without an aRHA. ConclusionsThe presence of an aRHA in patients with PA does not affect resectability. In patients with resectable tumours, the presence of an aRHA does not increase morbidity or R1 resection rates and does not impact on overall survival.

Morbidity in long-term survivors after pancreatoduodenectomy for pancreatic adenocarcinoma.

307 Background: Because the focus of pancreatoduodenectomy for pancreatic adenocarcinoma is placed on disease-free and overall survival, morbidity in long-term survivors is not well described. We sought to evaluate outcomes of long-term survivors of pancreatic cancer after pancreatoduodenectomy. Methods: We identified 30 patients from our prospectively collected database of patients with pancreatic adenocarcinoma who had undergone pancreatoduodenectomy, and who were without evidence of disease with at least 40 months of follow-up. Demographics, treatment and pathologic characteristics were collected for review. Data with regards to long-term sequelae were also collected, particularly those complications requiring additional procedures and the development of metachronous cancers. Results: The median length of follow up was 83 months, with 60% of patients still alive. Half the patients were male, and the median age at diagnosis was 70 years. With regard to treatment, 80% of patients received chemoradiation, with half of these patients receiving it in the neoadjuvant setting. All patients received an R0 resection, although two patients required at least partial resection of the superior mesenteric or portal veins. Thirty-three percent of patients had N1 disease. Forty-four percent of patients did not have any significant subsequent sequelae. In the remainder, four patients (13%) developed ascites requiring repeated paracentesis or Denver shunt, with median time to development (MTD) of 63 months. Six patients (20%) developed a biliary stricture requiring stent placement (MTD 56 months), one patient developed portal venous thrombosis requiring a venous stent (MTD 52 months), and 3 patients (10%) experienced clinically significant gastric anastomotic ulcers (MTD 47 months). With regards to metachronous cancers, 2 patients developed subsequent lymphomas (MTD 92 months). Conclusions: Long-term survivors of patients who undergo pancreatoduodenectomy for pancreatic adenocarcinoma can develop significant late sequelae, which often can manifest more than three to five years after surgery. Continued follow-up and counseling is warranted.

Reply to ‘Hospital Volume, Margin Status, and Long-term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma’ (Am Surg 2012;78:225–9)

Reply to ‘Hospital Volume, Margin Status, and Long-term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma’ (Am Surg 2012;78:225–9)

Mapping Patterns of Local Recurrence After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: A New Approach to Adjuvant Radiation Field Design

To generate a map of local recurrences after pancreaticoduodenectomy (PD) for patients with resectable pancreatic ductal adenocarcinoma (PDA) and to model an adjuvant radiation therapy planning treatment volume (PTV) that encompasses a majority of local recurrences. Consecutive patients with resectable PDA undergoing PD and 1 or more computed tomography (CT) scans more than 60 days after PD at our institution were reviewed. Patients were divided into 3 groups: no adjuvant treatment (NA), chemotherapy alone (CTA), or chemoradiation (CRT). Cross-sectional scans were centrally reviewed, and local recurrences were plotted to scale with respect to the celiac axis (CA), superior mesenteric artery (SMA), and renal veins on 1 CT scan of a template post-PD patient. An adjuvant clinical treatment volume comprising 90% of local failures based on standard expansions of the CA and SMA was created and simulated on 3 post-PD CT scans to assess the feasibility of this planning approach. Of the 202 patients in the study, 40 (20%), 34 (17%), and 128 (63%) received NA, CTA, and CRT adjuvant therapy, respectively. The rate of margin-positive resections was greater in CRT patients than in CTA patients (28% vs 9%, P=.023). Local recurrence occurred in 90 of the 202 patients overall (45%) and in 19 (48%), 22 (65%), and 49 (38%) in the NA, CTA, and CRT groups, respectively. Ninety percent of recurrences were within a 3.0-cm right-lateral, 2.0-cm left-lateral, 1.5-cm anterior, 1.0-cm posterior, 1.0-cm superior, and 2.0-cm inferior expansion of the combined CA and SMA contours. Three simulated radiation treatment plans using these expansions with adjustments to avoid nearby structures were created to demonstrate the use of this treatment volume. Modified PTVs targeting high-risk areas may improve local control while minimizing toxicities, allowing dose escalation with intensity-modulated or stereotactic body radiation therapy.

Authors’ Response

HomeRadioGraphicsVol. 33, No. 6 PreviousNext Head and Neck NeoplasmsAuthors’ ResponseFabio M. PaesFabio M. PaesAuthor AffiliationsDepartment of Radiology, University of Miami, Jackson Memorial Hospital Miami, FloridaFabio M. PaesPublished Online:Oct 1 2013https://doi.org/10.1148/Radiographics.33.6.3361738MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished online: Oct 1 2013Published in print: Oct 2013 FiguresReferencesRelatedDetailsRecommended Articles CT-based Radiomic Signatures for Predicting Histopathologic Features in Head and Neck Squamous Cell CarcinomaRadiology: Imaging Cancer2020Volume: 2Issue: 3Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the ArtRadioGraphics2019Volume: 39Issue: 7pp. 2055-2068PET of Fibroblast-Activation Protein for Cancer Staging: What We Know and What We Need to LearnRadiology2022Volume: 304Issue: 3pp. 658-659Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient CareRadiology2016Volume: 281Issue: 3pp. 816-825Adverse Radiation Therapy Effects in the Treatment of Head and Neck TumorsRadioGraphics2022Volume: 42Issue: 3pp. 806-821See More RSNA Education Exhibits The Utility of PET/MR in Head and Neck CancerDigital Posters2018Perineural Spread of Head and Neck Tumors: Review of Trigeminal and Facial Nerves Interconnections  Digital Posters2020Perineural Tumor Spread (PNTS) of Head and Neck Cancers: Imaging Technique and FindingsDigital Posters2019 RSNA Case Collection Acute Invasive Fungal SinusitisRSNA Case Collection2022 Post vaccination axillary adenopathyRSNA Case Collection2021Dedifferentiated Thyroid CancerRSNA Case Collection2020 Vol. 33, No. 6 Metrics Altmetric Score PDF download

KRAS mutation analysis in ductal carcinoma of the pancreas; prognostic implications in elderly patients

Ductal adenocarcinoma of the pancreas is one of the highly aggressive tumors; the overall survival rate of less than 6% is probably due to biological rapid development and late tumor stage at the time of diagnosis [1]. Recently a progression model suggested that infiltrating pancreatic cancer arises from pancreatic duct lesions that shows to harbour activating KRAS point mutation [2]. Since 1988 KRAS is the most significant genetic alteration in pancreatic cancer and is considered as an early event in tumor progression [3]. In the present study we investigated a selected population of patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma, with disease free resection margins, in order to evaluate whether a specific mutation could be related to a worst median survival time or onset of tumor recurrence and metastatisation.

Number of examined lymph nodes and nodal status assessment in pancreaticoduodenectomy for pancreatic adenocarcinoma

The accuracy of the assessment of the nodal status in resected cephalic pancreatic adenocarcinoma (PA) depends on the number of examined lymph nodes (NELN). This study assesses the impact of the NELN on N staging and survival and propose a minimal number of examined lymph nodes (MNELN) ensuring reliability of the pN status determination. 188 consecutive patients treated by pancreaticoduodenectomy (PD) for PA. Correlations between NELN and survivals of pN0 and pN1 groups and with the rate of pN1 patients were studied. A probability model based on the binomial law was built to estimate the MNELN able to detect pN1 patients with a sensitivity ≥ 95%. Overall and disease free 5-year survivals were 27.2% and 24.6% respectively. 135 patients (71.8%) were staged pN1. The median NELN was 17 (range 0-68). Overall and disease free survivals of pN1 patients were not related to NELN. The influence of NELN on survival in pN0 patients due to stage migration did not reach significance. The probability model showed that a MNELN of 16 nodes was required to detect pN1 patients with a sensitivity of 95%. A MNELN of 16 is required to assess pN status and should be considered as a quality criterion in future studies and trials on PD for PA.

Nontherapeutic Celiotomy Incidence is not Affected by Volume of Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Nontherapeutic celiotomy for pancreatic adenocarcinoma is detrimental to patients by delaying medical treatment as a result of unnecessarily incurred postoperative recovery time. This study was undertaken to evaluate whether surgeon volume of pancreaticoduodenectomy for pancreatic adenocarcinoma impacted the incidence of nontherapeutic celiotomy. All patients undergoing an intended pancreaticoduodenectomy for pancreatic adenocarcinoma were evaluated from 2003 to 2012. Survival was calculated using Kaplan-Meier analysis. The association between surgeon volume of pancreaticoduodenectomy and occurrence of nontherapeutic celiotomy was assessed using Fisher's exact test. Median data are presented. Eight surgeons undertook 443 intended pancreaticoduodenectomies for patients with pancreatic adenocarcinoma; 329 (74%) patients underwent pancreaticoduodenectomy, whereas 114 (26%) patients underwent nontherapeutic celiotomies. Two surgeons undertook 85 per cent of operations. Surgeon volume did not impact the incidence of nontherapeutic celiotomies (P = 0.26). Seventy-seven (68%) patients had metastatic disease at the time of the operation, whereas 37 (32%) patients had locally advanced unresectable disease. These patients had survivals of 5.0 and 6.0 months, respectively (P = 0.77). A high proportion of patients--one in four--undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma will ultimately undergo a nontherapeutic celiotomy. Surgeon volume of pancreaticoduodenectomy for pancreatic adenocarcinoma does not lessen the incidence of nontherapeutic celiotomies. Preoperative prediction of patients with imaging-occult metastatic or locally advanced disease remains a challenge, even for high-volume surgeons. Attempts to create algorithms for patients with high risk of imaging-occult metastatic or locally advanced disease to undergo staging laparoscopy and/or positron emission tomography scanning may decrease the burden of patients undergoing nontherapeutic celiotomies.

Is it Time to Stop Checking Frozen Section Neck Margins During Pancreaticoduodenectomy?

Residual disease after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) adversely impacts survival. The value of taking additional neck margin after a positive frozen section (FS) to achieve a negative margin remains uncertain. All patients who underwent PD for PDAC from January 2000 August 2012 were identified and classified as negative (R0) or positive (R1) based on final neck margin. We examined factors for association with a positive FS neck margin and overall survival (OS). We assessed the value of converting an R1 neck margin to R0 via additional parenchymal resection. A total of 382 patients had FS neck margin analysis, of which 53 (14%) were positive. Positive FS neck margin was associated with decreased OS (11.1 vs. 17.3months, p=0.01) on univariate analysis. On multivariate analysis poor histologic grade (p=0.007), increased tumor size (p=0.003), and a positive retroperitoneal margin (p=0.009) were independently associated with decreased OS, but positive FS neck margin was not. Of the 53 patients with positive FS, 41 underwent additional neck resection and 23 were converted to R0. On permanent section, R0 neck margin was achieved in 322 patients (84%), R1 in 37 patients (10%), and R1 converted to R0 in 23 patients (6%). Both the converted and the R1 groups had significantly poorer OS than the R0 group (11.3 vs. 11.1 vs. 17.3months respectively; p=0.04). Positive FS margin at the pancreatic neck during PD for PDAC is associated with poor survival. Extending the neck resection after a positive FS to achieve R0 margin status does notappear to improve OS.

Factors affecting the administration of adjuvant therapy in patients with pancreatic adenocarcinoma.

e15087 Background: Adjuvant therapy for pancreatic adenocarcinoma is now considered standard of care. The proportion of patients receiving adjuvant therapy (ADT) following pancreatic resection is a good quality indicator of cancer care. The aim of this study was to evaluate factors associated with receiving ADT in patients with pancreatic cancer. Methods: Between years 2000-2010, all patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma at a single high-volume hepatotopancreatobiliary center were evaluated. The impact of demographic, peri-operative and pathological risk factors affecting the administration of ADT were analyzed using univariate and multivariate logistic regression analysis. Results: There were 258 patients identified. Median age was 65 (37-84) years, 54% were females. There was a 15% margin positivity rate, 14% pancreatic leak rate, 14.7% major complication rate, and 1.2% 90 day/in-hospital mortality rate. Overall, 160/258 (70%) of patients received adjuvant therapy. On multivariate analysis; age, presence of major complications, node-negative disease and earlier era (2000-2004) were significantly associated with a lower probability of receiving ADT. Reasons for not receiving ADT were; patient preference: 20/67 (32%), not recommended: 14/67 (23%), disease recurrence: 12/67 (9.5%) and being medically unfit for ADT: 18/67 (11.5%). None of these reasons were different between time-periods except for fewer patients being offered ADT from 2000-2005 (15.4% vs. 2.5%, p &lt;0.001). Conclusions: Thirty percent of patients do not receive ADT following pancreatectomy. Those with advanced age; node-negative disease and those who had major complications after pancreaticoduodenectomy were less likely to receive ADT. The impact of these factors should be taken into account when considering the administration of ADT.

Tu1576 Surgical Apgar Score Does Not Predict Morbidity and Mortality for Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

S A T A b st ra ct s 51.9%, electrocautery 34.6%, ultrasonic scalpel 8.4%, saline coupled radio frequency ablation (RFA) 3.17% and scalpel 1.8%. The visible pancreatic duct and/or parenchymawere oversewn in 73%. In 21.6%, pancreatic stump was treated with the RFA device. Clinically significant leak was seen in 3.4% of patients whose pancreas was transected with a stapler and oversewn versus 15.3% of patients in whose pancreas was stapled. Patients whose pancreas was transected using the scalpel or an energy device and treated with RFA had a 13.3% CSL rate. Pancreas transected using a stapler and the stump treated with RFA had a 19.2% CSL rate, whereas oversewing a pancreatic margin that had been treated with the RFA device had a 28.6% clinically significant leak rate. A patient with transected margin treated with oversewn relative to a patient whose pancreas transected with stapler and oversewn was at highest risk for CSL [p = ,0.001, OR 11.5 (CI 3.1 42.4)]. In univariate models, the use of the RFA device and oversewing of the pancreatic duct were predictors of a CSL (p ,0.05). On evaluating various modes of transection, there was interaction of RFA with oversewing and stapling with oversewing of the pancreatic stump (p ,0.001)]. Conclusion: Among various methods available for pancreatic transection during DP, many of them recent technologies, none have a clinical superiority. Using the stapler to transect the pancreas has a higher rate of clinically significant leak as compared to treating the transected stump with RFA. Using the RFA device in addition to a stapler or oversewing the transected margin has a higher rate of clinically significant leak and should not be attempted. Randomized trials of newer technologies to help solve this age old dilemma are necessary.

The natural history of preoperative indeterminate pulmonary nodules in patients with resectable pancreatic adenocarcinoma.

161 Background: Preoperative abdominal imaging often detects indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma. The natural history of IPN in this setting is not well characterized. Methods: Patients with adenocarcinoma of the head of the pancreas who underwent pancreaticoduodenectomy (PD) were queried from a prospectively maintained database. Pre- and postoperative imaging was reviewed and IPN characterized and analyzed for associations with nodule progression and overall survival (OS). Results: 463 patients underwent PD for adenocarcinoma of the head of the pancreas from 2000-2010. Of these, 329 (71%) had reviewable pre-operative imaging. 48 patients (15%) had pre-operative IPN (non-calcified) identified with follow-up imaging available for review. The only pre-operative factor associated with the presence of IPN was increasing age (68 v. 64 years; p=0.003). 8 patients (12%) had new or enlarging nodules, of whom 5 (7%) had confirmed pulmonary metastatic adenocarcinoma. There was no difference in OS between patients with or without pre-operative IPN (2-year OS 41% v. 38%, respectively; p=0.37). Further, no radiographic criteria of IPN (including # of, size of, bilateral, calcified, solid, spiculated, smooth, lobular, or ground-glass nodules) was associated with OS. On follow-up, new or enlarging nodules were not associated with OS. Conclusions: IPN are often found in patients undergoing PD for pancreatic adenocarcinoma. The majority of IPN remain stable on post-operative imaging. Neither the presence of IPN nor nodule characteristics was associated with OS. These data do not support the routine additional workup of pre-operative IPN in patients with resectable adenocarcinoma of the head of the pancreas; however, larger studies are needed to further characterize the significance of IPN in the preoperative evaluation of patients with pancreatic adenocarcinoma.

15. How frequently is breast conservation possible after neoadjuvant chemotherapy in women with breast cancer – Overview of our surgical practice

15. How frequently is breast conservation possible after neoadjuvant chemotherapy in women with breast cancer – Overview of our surgical practice

17. ESSO major fellowship 2010–2011 – Impact of obesity and body fat distribution on survival after pancreaticoduodenectomy for pancreatic adenocarcinoma

17. ESSO major fellowship 2010–2011 – Impact of obesity and body fat distribution on survival after pancreaticoduodenectomy for pancreatic adenocarcinoma

PMO-217 Preoperative endoscopic biliary drainage and short-term clinical outcome following pancreaticoduodenectomy for pancreatic adenocarcinoma: site-specific factors

IntroductionThe role of preoperative endoscopic biliary drainage (PEBD) prior to pancreaticoduodenectomy (PD) remains controversial. We sought to determine the effects of PEBD on the short-term outcome of initially jaundiced patients...

Impact of Obesity and Body Fat Distribution on Survival After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Epidemiologic studies have reported a positive correlation between body mass index (BMI) and pancreatic cancer risk, but clinical relevance of obesity and/or body fat distribution on tumor characteristics and cancer-related outcome remain controversial. We sought to assess the influence of obesity and body fat distribution on pathologic characteristics and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Demographic and biometric data were collected on 328 patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. In a subset of patients, pancreatic fatty infiltration and fibrosis were assessed pathologically, and visceral fat area (VFA) was evaluated. Influence of BMI and body fat distribution on tumor characteristics and survival were evaluated. A significant positive correlation between BMI and VFA was observed, with a wide range of VFA value within each BMI class. According to BMI or VFA distribution, there were no significant differences in patient characteristics, intraoperative or perioperative outcome, or pathologic characteristics, with the exception of significantly higher blood loss in patients with an increased body weight or VFA. Unadjusted overall and disease-free survival between BMI class and VFA quartile were not significantly different. In this study, obesity and body fat distribution were not correlated with specific tumor characteristics or cancer-related outcome.

Hospital Volume, Margin Status, and Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers (P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year, respectively (P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals dedicated to pancreatic surgery.