Background

Positive margins in pancreatoduodenectomy (PD) for pancreatic cancer, specifically the superior mesenteric artery (SMA) margin, are associated with worse outcomes. Local therapies targeting these margins could impact on recurrence. This study analysed recurrence-patterns to identify whether strategies to control local disease could have a meaningful impact.

Methods

(I) Systematic review to define recurrence patterns and resection margin status. (II) Additional retrospective study of PD performed at our centre.

Results

In the systematic review, 23/617 evaluated studies were included (n = 3815). Local recurrence was observed in 7–69%. SMA margin (6 studies) was positive in 15–35%. In the retrospective study (n = 204), local recurrence was more frequently observed with a positive SMA margin (66 vs.45%; p = 0.005). Furthermore, in a multivariate cox-proportional hazard model, only a positive SMA margin was associated with disease recurrence (HR 1.615; 95%CI 1.127–2.315; p = 0.009). Interestingly, median overall survival was 20 months and similar for patients who developed local only, metastases only or simultaneous recurrence (p = 0.124).

Conclusion

Local recurrence of pancreatic cancer is common and associated with similar mortality rates as those who present with simultaneous or metastatic recurrence. Involvement of the SMA margin is an independent predictor for disease progression and should be the target of future adjuvant local therapies.

中文翻译：

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胰十二指肠切除术后胰腺癌的复发模式：系统评价和单中心回顾性研究。

背景

胰腺癌胰十二指肠切除术 (PD) 的阳性切缘，特别是肠系膜上动脉 (SMA) 切缘，与较差的结果相关。针对这些边缘的局部疗法可能会影响复发。这项研究分析了复发模式，以确定控制局部疾病的策略是否会产生有意义的影响。

方法

(I) 系统审查以定义复发模式和切缘状态。(II) 在我们中心进行的额外 PD 回顾性研究。

结果

在系统评价中，纳入了 23/617 项评估研究（n  = 3815）。在 7-69% 中观察到局部复发。SMA 边缘（6 项研究）阳性率为 15-35%。在回顾性研究 ( n  = 204) 中，SMA 边缘阳性更常观察到局部复发（66% vs.45%；p  = 0.005）。此外，在多变量 cox 比例风险模型中，只有正 SMA 边缘与疾病复发相关（HR 1.615；95%CI 1.127–2.315；p  = 0.009）。有趣的是，中位总生存期为 20 个月，与仅发生局部、仅转移或同时复发的患者相似（p  = 0.124）。

结论

胰腺癌的局部复发很常见，死亡率与同时或转移性复发的患者相似。SMA 边缘受累是疾病进展的独立预测因子，应成为未来辅助局部治疗的目标。