48 - Preissitzung
Felix Largiadèr Preissitzung
16. Mai 2019, 10:15 - 11:45, Bellavista 3+4, 6. OG
Impact on survival and recurrence of positive histological resection after pancreatoduodenectomy in patients with lymph node invasion: An international multicentric study
G.-R. Joliat1, P. Allemann1, I. Labgaa1, J. Sulzer2, D. Vrochides2, A. Zerbi3, G. Nappo3, J. Perinel4, M. Adham4, M. Nentwich5, J. Izbicki5, N. Demartines1, M. Schäfer1, Presenter: G.-R. Joliat1 (1Lausanne, 2Charlotte/USA, 3Milan/IT, 4Lyon/FR, 5Hamburg/DE)
Incomplete resection (R1) after pancreatoduodenectomy and lymph node (LN) invasion have been described as factors of poor prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). It is nevertheless unclear if R0 resection after pancreatoduodenectomy compared to R1 resection has a real positive impact on survival and recurrence in patients with LN invasion. This study aimed to compare overall survival (OS) and recurrence rate between R0 and R1 resections among PDAC patients with LN invasion.
A retrospective international multicentric study was performed including 5 tertiary centers (1 in the USA and 4 in Europe). Patients with PDAC without neoadjuvant treatment were included. R1 resection was defined as positive histological margins. Survival was measured from operation date to last follow-up date or death. Median OS was calculated using Kaplan-Meier curves and compared using log-rank tests. Multivariable Cox regression analysis was performed to find negative predictive factors for OS.
From the 5 participating centers, 990 patients with pancreatoduodenectomy for PDAC were included. A total of 789 patients had LN invasion (80%) and 201 had no LN invasion (20%). Perioperative mortality was 3% (30/990) and overall morbidity 60% (593/990). For the entire cohort, median OS was 24 months (95% CI: 22-26). Median OS was longer for patients without LN invasion compared to patients with LN invasion (45 vs. 21 months, p<0.001). Recurrence after R0 resection was also lower in patients without LN invasion (26%) compared to patients with LN invasion (52%, p<0.001). Among patients with LN invasion, median OS was similar between patients with R0 and R1 resection (25 vs. 22 months, p=0.646). Recurrence rates were also similar between R0 and R1 resections (209/391=53% vs. 195/355=55%, p=0.686). On multivariable analysis R1 resection was not an independent factor of worse OS (HR: 0.9, 95% CI: 0.8-1.2, p=0.958). Only tumor size was associated with poor OS (HR: 1.1, 95% CI: 1-1.1, p=0.045).
In PDAC patients with pathological positive LN invasion, resection status had no influence on OS and recurrence rates. Extensive surgery to achieve R0 resection in such patients might not influence the course of the disease.