Abstract：
UNLABELLED: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.
journal_name
Surgeryjournal_title
Surgeryauthors
Schmidt CM,Glant J,Winter JM,Kennard J,Dixon J,Zhao Q,Howard TJ,Madura JA,Nakeeb A,Pitt HA,Cameron JL,Yeo CJ,Lillemoe KDdoi
10.1016/j.surg.2007.07.016subject
Has Abstractpub_date
2007-10-01 00:00:00pages
572-8; discussion 578-80issue
4eissn
0039-6060issn
1532-7361pii
S0039-6060(07)00437-0journal_volume
142pub_type
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