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Standardization of pancreatic cancer specimen pathological examination


Authors: J. Hlavsa 1;  V. Procházka 1;  J. Mazanec 2;  J. Hausnerová 2;  T. Pavlík 3;  T. Andrašina 4;  I. Novotný 5;  I. Penka 1;  Z. Kala 1
Authors‘ workplace: Chirurgická klinika LF MU FN Brno-Bohunice, přednosta: Prof. MUDr. Z. Kala, CSc. 1;  Patologicko-anatomický ústav LF MU FN Brno-Bohunice: Doc. MUDr. L. Křen, Ph. D. 2;  Institut biostatistiky a analýz LFMU Brno: Doc. RNDr. L. Dušek, Ph. D. 3;  Radiologická klinika LF MU FN Brno-Bohunice: Prof. MUDr. V. Válek CSc, MBA 4;  Gastroenterologické oddělení MOU Brno: prim. MUDr. M. Šachlová, Ph. D. 5
Published in: Rozhl. Chir., 2014, roč. 93, č. 3, s. 132-138.
Category: Original articles

Overview

Introduction:
The frequency of R1 resections for pancreatic cancer in studies where a non-standardized protocol of pathological evaluation of the specimen is used varies from 17 to 30%. The aim of our study is to apply the standardized (so-called Leeds) protocol of resected pancreatic specimen pathological examination, and to evaluate the frequency of R1 resections for pancreatic cancer using this new protocol.

Material and methods:
Ninety-one patients who underwent pancreatoduodenectomy for pancreatic cancer were included in the study. This group was divided into two subgroups: patients examined by the Leeds protocol (n=20) and those examined by a non-standardized pathological protocol (n=71). The R1 resection rate was evaluated separately in each group. The positivity rate of every individual resection margin was specified in the Leeds protocol group. The correlation of R1 resection rate and “tumour - resection margin distance” parameter was evaluated. The tumour infiltration of peripancreatic adipose tissue was assessed in the non-standardized group.

Results:
In the Leeds protocol subgroup, R1 and R0 resection rate was 60% (12/20) and 40% (8/20), respectively. Resection line positivity rates were as follows: dorsal 45% (9/20), ventral 35% (7/20), VMS 20% (4/20), cervical 20% (4/20), AMS 15% (3/20). The correlation between the tumour - resection line distance and R1 resection frequency was the following: direct infiltration 30% R1, tumour-resection margin border ≤0.5 mm 50% R1, ≤1mm 60%, ≤ 1.5 mm 75% R1, ≤2 mm 80% R1, >2 mm 80% R1. If the criterion of resection line positivity (≤ 1mm) was set, the R1 resection rate difference between the two groups was of statistical significance.

In the subgroup where the non-standardized protocol was used (n=71), R1 resection was recorded in 25 (35.2%) patients. The main cancer-positive areas were peripancreatic adipose tissue in 26.8% (19/71) of cases, and VMS, AMS or retroperitoneal line in 8.5% (6/71), respectively. R0 resection was achieved in 46 (64.8%) patients.

The statistically significant (p=0.046) difference in R0 and R1 resection rates was detected (Leeds protocol and non-standardized one: R0 40.0% vs. 64.8% and R1 60.0% vs. 35.2%, respectively) in the studied groups.

Conclusion:
The rate of R1 resections for pancreatic cancer increased in all studies, including ours, where the standardized (Leeds) protocol of pancreatic specimen pathological examination was used. The higher R1 resection rate when using the Leeds protocol is approaching to the local recurrence rate of pancreatic cancer. Therefore, the Leeds protocol can provide more realistic evaluation of local radicality of pancreatoduodenectomy and can also offer more accurate evaluation of the surgical and adjuvant therapy of pancreatic cancer.

Key words:
pancreas – cancer – pathology


Sources

1. Neoptolemos JP, Stocken DD, Dunn JA, et al. European Study Group for Pancreatic Cancer. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234:758–68.

2. Raut CP, Tseng JF, Sun CC, Wang H, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 2007;246:52–60.

3. Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;6:567–79.

4. Millikan KW, Deziel DJ, Silverstein JC, et al. Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas. Am Surg 1999;65:618–23.

5. Verbeke CS, Leitch D, Menon KV, et al. Redefining the R1 resection in pancreatic cancer. British Journal of Surgery 2006;93:1232–1237.

6. Esposito I, Kleeff J, Bergmann F, et al. Most Pancreatic Cancer Resections are R1 Resections. Annals of Surgical Oncology 2008;15:1651–1660.

7. Campbell F, Smith RA, Whelan P, et al. Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology 2009;55:277–83.

8. Nigel B. Jamieson, Nigel I. J. Chan, Alan K, et al. The Prognostic Influence of Resection Margin Clearance Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma. J Gastrointest Surg 2013;17:511–521.

9. Dušek L, et al. Czech cancer care in numbers 2008–2009. Praha, Grada Publishing 2009.

10. Žaloudík J. Diagnostický deficit I. a II. typu a důsledky pro onkoterapii. Rozhledy v chirurgii 2013;92:123–124.

11. Inoue S, Nakao A, Kasai I, et al. Detection of hepatic micrometastasis in pancreatic adenocarcinoma patients by two-stage polymerase chain reaction/restriction fragment length polymorphism analysis. Jpn J Cancer Res 1995;86:626–30.

12. Thorban S, Roder JD, Pantel K, et al. Epithelial tumour cells in bone marrow of patients with pancreatic carcinoma detected by immunocytochemical staining. Zentralbl Chir 1996;121:487–9; discussion 490–2.

13. Klos D, Lovecek M, Skalicky P, et al. Minimal residual disease in pancreatic cancer—our first experiences. Rozhl chir 2010;89: 135–139.

14. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 2004;139:718–725.

15. Raut CP, Tseng JF, Sun CC, et al, Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 2007;246:52–60.

16. Menon KV, Gomez D, et al. Impact of margin status on survival following pancreatoduodenectomy for cancer: the Leeds Pathology Protocol (LEEPP). HPB 2009;11:18–24.

17. Delpero JR, Bachellier P, Regenet N, et al. Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimen. HPB (Oxford). 2013 Mar 7. doi: 10.1111/hpb.12061. [Epub ahead of print].

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