In patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma
(PC), conversion to total pancreatectomy (TP) may be necessary to achieve R0 resection.
Hypothesis
We sought to examine the oncologic benefit of conversion of PD to TP to achieve an
R0 resection in patients with an isolated positive neck margin.
Methods
We conducted a retrospective analysis of prospectively collected data at Indiana University
and Johns Hopkins Medical Institutions. A review of 1,579 patients who underwent PD
or TP for PC at these institutions between 1992 and 2006 was performed. Sixty-one
patients were eligible.
Results
Twenty-eight patients underwent PD with an isolated positive neck margin found on
pathologic examination; 33 patients had conversion to TP for isolated neck margin
involvement to achieve R0 resection. Patients undergoing TP versus PD had a greater
median survival (18 vs 10 months; P = .04). Mortality (6% vs 7%) and morbidity (36% vs 54%; P = .20) for TP versus PD were comparable. Multivariate analysis revealed PD and greater
tumor size as the only independent predictors of poor long-term survival (hazard ratio
[HR], 2.2; P = .01 and HR, 1.3; P = .005).
Conclusions
Conversion of PD to TP to achieve an R0 resection in patients with pancreatic adenocarcinoma
is associated with a survival benefit.
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Article info
Publication history
Accepted:
July 13,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
