Mesopancreatic excision for pancreatic ductal adenocarcinoma improves local disease control and survival

Background: Survival in ductal adenocarcinoma of the pancreatic head (hPDAC) is poor. After implementation of the circumferential resection margin (CRM) into standard histopathological evaluation, the margin negative resection rate has drastically dropped. However, the impact of surgical radicality on survival and the influence of malignant infiltration of the mesopancreatic fat remains unclear. At our institution, a standardized dissection of the mesopancreatic lamina and peri-pancreatic vessels are obligatory components of radical pancreatoduodenectomy. The aim of our study was to histopathologically analyze mesopancreatic tumor infiltration and the influence of CRM-evaluated resection margin on relapse-free and overall survival. Method: Clinicopathological and survival parameters of 264 consecutive patients who underwent surgery for hPDAC were evaluated. Results: The rate of R0 resection R0(CRM-) was 48.5%, after the implementation of CRM. Mesopancreatic fat infiltration was evident in 78.4% of all consecutively treated patients. Patients with mesopancreatic fat infiltration were prone to lymphatic metastases (N1 and N2) and had a higher rate of positive resection margin (R1/R0(CRM thorn )). In multivariate analysis, only R0 resection was shown to be an independent prognostic parameter. Local recurrence was diagnosed in only 21.1% and was significantly lower in patients with R0(CRM-) resected hPDACs (10.9%, p < 0.001). Conclusion: Mesopancreatic excision is justified, since mesopancreatic fat invasion was evident in the majority of our patients. It is associated with a significantly improved local tumor control as well as longer relapse-free and overall survival. (c) 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Automated summary

After CRM implementation, the R0 resection rate was 48.5% and mesopancreatic fat infiltration was seen in 78.4% of patients. Patients with mesopancreatic fat infiltration were more prone to lymphatic metastases, and R0 resection was identified as an independent prognostic factor. Local recurrence rate was significantly lower in patients with R0(CRM-) resection.