Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis.

Autor:	Leonhardt CS; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Hank T; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Pils D; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Gustorff C; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Sahora K; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Schindl M; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Verbeke CS; Department of Pathology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Strobel O; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Klaiber U; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria.
Jazyk:	angličtina
Zdroj:	International journal of surgery (London, England) [Int J Surg] 2024 Jan 01; Vol. 110 (1), pp. 453-463. Date of Electronic Publication: 2024 Jan 01.
DOI:	10.1097/JS9.0000000000000792
Abstrakt:	Background: A greater than 1 mm tumour-free resection margin (R0 >1 mm) is a prognostic factor in upfront-resected pancreatic ductal adenocarcinoma. After neoadjuvant treatment (NAT); however, the prognostic impact of resection margin (R) status remains controversial. Methods: Randomised and non-randomised studies assessing the association of R status and survival in resected pancreatic ductal adenocarcinoma after NAT were sought by systematic searches of MEDLINE, Web of Science and CENTRAL. Hazard ratios (HR) and their corresponding 95% CI were collected to generate log HR using the inverse-variance method. Random-effects meta-analyses were performed and the results presented as weighted HR. Sensitivity and meta-regression analyses were conducted to account for different surgical procedures and varying length of follow-up, respectively. Results: Twenty-two studies with a total of 4929 patients were included. Based on univariable data, R0 greater than 1 mm was significantly associated with prolonged overall survival (OS) (HR 1.76, 95% CI 1.57-1.97; P<0.00001) and disease-free survival (DFS) (HR 1.66, 95% CI 1.39-1.97; P<0.00001). Using adjusted data, R0 greater than 1 mm was significantly associated with prolonged OS (HR 1.65, 95% CI 1.39-1.97; P<0.00001) and DFS (HR 1.76, 95% CI 1.30-2.39; P=0.0003). Results for R1 direct were comparable in the entire cohort; however, no prognostic impact was detected in sensitivity analysis including only partial pancreatoduodenectomies. Conclusion: After NAT, a tumour-free margin greater than 1 mm is independently associated with improved OS as well as DFS in patients undergoing surgical resection for pancreatic cancer. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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