Informing Decision-making for Transected Margin Reresection in Intraductal Papillary Mucinous Neoplasm-derived PDAC: An International Multicenter Study.

Autor:	Habib JR; New York University Langone Health, Department of Surgery, New York, USA.; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Rompen IF; New York University Langone Health, Department of Surgery, New York, USA.; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, the Netherlands., Kinny-Köster B; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Campbell BA; Johns Hopkins Hospital, Department of Surgery, Baltimore, USA., Andel PCM; New York University Langone Health, Department of Surgery, New York, USA.; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Sacks GD; New York University Langone Health, Department of Surgery, New York, USA., Billeter AT; Clarunis University Digestive Health Care Center Basel, Basel, Switzerland., van Santvoort HC; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Daamen LA; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands.; University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands., Javed AA; New York University Langone Health, Department of Surgery, New York, USA., Müller-Stich BP; Clarunis University Digestive Health Care Center Basel, Basel, Switzerland., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, the Netherlands., Büchler MW; Department of Pancreatic Surgery, Champalimaud Foundation, Lisbon, Portugal., He J; Johns Hopkins Hospital, Department of Surgery, Baltimore, USA., Wolfgang CL; New York University Langone Health, Department of Surgery, New York, USA., Molenaar IQ; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Loos M; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Sep 12. Date of Electronic Publication: 2024 Sep 12.
DOI:	10.1097/SLA.0000000000006532
Abstrakt:	Objective: To assess the prognostic impact of margin status in patients with resected intraductal papillary mucinous neoplasms (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and to inform future intraoperative decision-making on handling differing degrees of dysplasia on frozen section. Summary Background Data: The ideal oncologic surgical outcome is a negative transection margin with normal pancreatic epithelium left behind. However, the prognostic significance of reresecting certain degrees of dysplasia or invasive cancer at the pancreatic neck margin during pancreatectomy for IPMN-derived PDAC is debatable. Methods: Consecutive patients with resected and histologically confirmed IPMN-derived PDAC (2002-2022) from six international high-volume centers were included. The prognostic relevance of a positive resection margin (R1) and degrees of dysplasia at the pancreatic neck margin were assessed by log-rank test and multivariable Cox-regression for overall survival (OS) and recurrence-free survival (RFS). Results: Overall, 832 patients with IPMN-derived PDAC were included with 322 patients (39%) having an R1-resection on final pathology. Median OS (mOS) was significantly longer in patients with an R0 status compared to those with an R1 status (65.8 vs. 26.3 mo P<0.001). Patients without dysplasia at the pancreatic neck margin had similar OS compared to those with low-grade dysplasia (mOS: 78.8 vs. 66.8 months, P=0.344). However, high-grade dysplasia (mOS: 26.1 mo, P=0.001) and invasive cancer (mOS: 25.0 mo, P<0.001) were associated with significantly worse OS compared to no or low-grade dysplasia. Patients who underwent conversion of high-risk margins (high-grade or invasive cancer) to a low-risk margin (low-grade or no dysplasia) after intraoperative frozen section had significantly superior OS compared to those with a high-risk neck margin on final pathology (mOS: 76.9 vs. 26.1 mo P<0.001). Conclusions: In IPMN-derived PDAC, normal epithelium or low-grade dysplasia at the neck have similar outcomes while pancreatic neck margins with high-grade dysplasia or invasive cancer are associated with poorer outcomes. Conversion of a high-risk to low-risk margin after intraoperative frozen section is associated with survival benefit and should be performed when feasible. Competing Interests: Disclosures: There are no conflicts of interest for any of the authors.Funding: Joseph R. Habib is supported by the NIH T32 grant T32CA193111. Ingmar F. Rompen is supported by the Swiss National Science Foundation (SNSF, grant number 217684). This work was also supported by the Ben and Rose Cole Charitable PRIA Foundation. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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