Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma

C. Max Schmidt, Jeffrey Glant, Jordan M. Winter, Jason Kennard, Jennifer Dixon, Qianqian Zhao, Thomas J. Howard, James A. Madura, Atilla Nakeeb, Henry A. Pitt, John L. Cameron, Charles J. Yeo, Keith D. Lillemoe

Research output: Contribution to journalArticle

87 Scopus citations

Abstract

In patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC), conversion to total pancreatectomy (TP) may be necessary to achieve R0 resection. Hypothesis: We sought to examine the oncologic benefit of conversion of PD to TP to achieve an R0 resection in patients with an isolated positive neck margin. Methods: We conducted a retrospective analysis of prospectively collected data at Indiana University and Johns Hopkins Medical Institutions. A review of 1,579 patients who underwent PD or TP for PC at these institutions between 1992 and 2006 was performed. Sixty-one patients were eligible. Results: Twenty-eight patients underwent PD with an isolated positive neck margin found on pathologic examination; 33 patients had conversion to TP for isolated neck margin involvement to achieve R0 resection. Patients undergoing TP versus PD had a greater median survival (18 vs 10 months; P = .04). Mortality (6% vs 7%) and morbidity (36% vs 54%; P = .20) for TP versus PD were comparable. Multivariate analysis revealed PD and greater tumor size as the only independent predictors of poor long-term survival (hazard ratio [HR], 2.2; P = .01 and HR, 1.3; P = .005). Conclusions: Conversion of PD to TP to achieve an R0 resection in patients with pancreatic adenocarcinoma is associated with a survival benefit.

Original languageEnglish (US)
Pages (from-to)572-580
Number of pages9
JournalSurgery
Volume142
Issue number4
DOIs
StatePublished - Oct 1 2007

ASJC Scopus subject areas

  • Surgery

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    Schmidt, C. M., Glant, J., Winter, J. M., Kennard, J., Dixon, J., Zhao, Q., Howard, T. J., Madura, J. A., Nakeeb, A., Pitt, H. A., Cameron, J. L., Yeo, C. J., & Lillemoe, K. D. (2007). Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma. Surgery, 142(4), 572-580. https://doi.org/10.1016/j.surg.2007.07.016