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Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma
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Abstracts / Pancreatology 12 (2012) 502–597
The purpose of the study: To examine indicators of TNF-a in the course and progression of CP in conjunction with CHD. Materials and methods: 23 patients with CP in concomitant with CHD, including 14 men and 9 women were examined. TNF-a was investigated by ELISA using a set of reagents, the company «Immunoenzyme assay-TNFalpha» production of «Cytokines» (St. Petersburg, Russia). Analysis of results and discussion: According to the obtained results: TNF-a levels in women were higher than in men. In patients with CP, which was accompanied by CHD a short time period (3-5 years) indicators of TNF-a were 117 14,52 pg / ml, with a combined length of period up to 10 years old - 91,52 26,01 pg / ml and more than 10 years of indicators of TNF-a were 83,12 15,41 pg / ml. Conclusion: In patients with CP in combination with CHD average level of TNF-a is not stable and decreases depending on the duration of the comorbidity of these pathologies, which appears to be due to inadequacy or inferiority of immune response and may indicate significant morphological and functional changes in the structure of the pancreas and the myocardium.
P64. Quality of life in patients with chronic pancreatitis: An analysis of results
Aims/objectives: To assess predictors of loco-recurrence, in order to tailor the indications for adjuvant chemoradiotherapy. Patients and methods: Prospective data for patients who underwent PD for PDAC (2001-2010) were retrieved. Tumor recurrence was categorized as loco-recurrence or distant recurrence. Clinico-pathological characteristics and survivals were compared between patients with different recurrence patterns. The predictors for loco-recurrence were assessed. Results: 79 patients were included. Loco-recurrence alone was identified in 22 patients (27.8%), distant recurrence alone in 33 (41.8%), both loco- and distant recurrences in 17 (21.5%) and no recurrence in 7 (8.9%). Median survival after recurrence (SAR) was significantly better in patients with loco-recurrence alone than those with distant recurrence alone (10.4 vs. 5.0 months, P¼0.002) or those with both loco- and distant recurrences (10.4 vs. 5.8 months, P¼0.044); the survival for patients with distant recurrence alone or with both patterns was identical. Patients with early recurrence had a significantly poorer SAR than those with late recurrence (median, 5.5 vs. 9.0 months, P¼0.001). Logistic regression analysis revealed that positive resection margin (P¼0.001, HR¼14.532; 95%CI 7.399-38.466), early T stage (P¼0.018, HR¼0.014; 95%CI 0.000-0.475) and large tumor size (P¼0.030, HR¼4.345; 95%CI 1.152-16.391) were the determinant factors directly related to loco-recurrence alone. Conclusions: Patients with PDAC loco-recurrence alone had a significantly better SAR than those with distant recurrence. Adjuvant chemoradiotherapy should be considered to reduce loco-recurrence further and improve long-term survival.
J.M. Teleki, D.A. Gontsaruyk, T.M. Khristich, O.J. Olinyk. Bukovynian State Medical University, Chernivtsi, Ukraine Introduction: Quality of life is one of the important indicators of adaptation abilities in patients (including those with chronic pancreatitis (CP)) to the social conditions of life. The purpose of the study: To study features of the quality of life (QoL) in patients with CP. Materials and methods: 32 CP patients in the acute stage at the age of 29 to 61 years (men - 21 women - 11) were examined. The diagnosis was verified on the basis of a thorough medical history, objective methods of research, laboratory, ELISA and instrumental data. QoL was assessed using the SF-36 test «Health Status Survey» which 100 points represents full health. The results were compared with the control group (20 almost healthy persons). Results: In patients with CP significantly reduced physical and role functioning (67,5 8,2 points and 32,9 9,2, respectively) compared with the control group (96,3 2,4 and 87,5 7,5). Vital activity was limited to 47,0 10,4 points, while in almost healthy it amounted to 77,5 4,2 points. Sleep disturbance was recorded at 45.6% and 43.7% poor coping with stress. Conclusion: These data confirm the particular violations of the quality of life during exacerbation of CP that must be considered in therapeutic practice.
P65. Loco-recurrence after resection for ductal adenocarcinoma of the pancreas: Predictors and implications for adjuvant chemoradiotherapy A.E. Frampton 1, Y. Zhang 1, C. Kyriakides 1, J.J. Bong 1, N.A. Habib 1, R. Ahmad 2, L.R. Jiao 1. 1 HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK 2 Dept. of Histopathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
Abstract Introduction: Loco (regional) recurrence rate after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains high and the efficiency of adjuvant chemoradiotherapy is still debated.
P66. Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma A.E. Frampton 1, Y. Zhang 1, P. Cohen 2, C. Kyriakides 1, J.J. Bong 1, N.A. Habib 1, D.R. Spalding 1, R. Ahmad 2, L.R. Jiao 1. 1
HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, United Kingdom 2 Dept. of Histopathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
Abstract Introduction: The relevance of R1 (microscopic tumor involvement) status in different surgical resection margins (RMs) after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated. Aims/objectives: To assess the rates of R1 resection in different RMs and analyse their prognostic influence on survival. Patients and methods: Data for patients who underwent PD (n¼258) in our hospital between January 2001-December 2010 were retrieved from a prospective database. Using our standardized pathological reporting protocol, the circumferential resection margin is distinguished as 4 RMs: pancreatic transection, medial, posterior and anterior surfaces. Results: A total of 84 patients were included with a median age of 63.7 years (range, 40.7–79.5 years). R1 rate was 57.1% (48/84) at all margins, 31.0% (26/84) in anterior margin, 42.9% (36/84) in posterior margin, 29.8% (25/84) in medial margin, and 7.1% (3/84) in pancreatic transection margin. The median overall and disease-free survival for all R1 resections were significantly poorer than those for R0 resection (17.2 vs. 28.7 months, P¼0.007; and 12.3 vs. 21.0 months, P¼0.019). Only medial margin positivity had a significant impact on survival (13.8 vs. 28.0 months, P <0.001), as opposed to anterior margin (19.7 vs. 23.3 months, P¼0.187) and posterior margin (17.5 vs. 24.2 months, P¼0.104) involvement. Multivariate analysis showed that medial margin R0 status was an independent prognostic factor (P¼0.002, HR¼0.381; 95% CI 0.207-0.701). Conclusions: With a standardized pathological reporting protocol, the medial surgical RM is the most important margin in PD for PDAC and a R1 resection here predicts poor survival.
Abstracts / Pancreatology 12 (2012) 502–597
The purpose of the study: To examine indicators of TNF-a in the course and progression of CP in conjunction with CHD. Materials and methods: 23 patients with CP in concomitant with CHD, including 14 men and 9 women were examined. TNF-a was investigated by ELISA using a set of reagents, the company «Immunoenzyme assay-TNFalpha» production of «Cytokines» (St. Petersburg, Russia). Analysis of results and discussion: According to the obtained results: TNF-a levels in women were higher than in men. In patients with CP, which was accompanied by CHD a short time period (3-5 years) indicators of TNF-a were 117 14,52 pg / ml, with a combined length of period up to 10 years old - 91,52 26,01 pg / ml and more than 10 years of indicators of TNF-a were 83,12 15,41 pg / ml. Conclusion: In patients with CP in combination with CHD average level of TNF-a is not stable and decreases depending on the duration of the comorbidity of these pathologies, which appears to be due to inadequacy or inferiority of immune response and may indicate significant morphological and functional changes in the structure of the pancreas and the myocardium.
P64. Quality of life in patients with chronic pancreatitis: An analysis of results
Aims/objectives: To assess predictors of loco-recurrence, in order to tailor the indications for adjuvant chemoradiotherapy. Patients and methods: Prospective data for patients who underwent PD for PDAC (2001-2010) were retrieved. Tumor recurrence was categorized as loco-recurrence or distant recurrence. Clinico-pathological characteristics and survivals were compared between patients with different recurrence patterns. The predictors for loco-recurrence were assessed. Results: 79 patients were included. Loco-recurrence alone was identified in 22 patients (27.8%), distant recurrence alone in 33 (41.8%), both loco- and distant recurrences in 17 (21.5%) and no recurrence in 7 (8.9%). Median survival after recurrence (SAR) was significantly better in patients with loco-recurrence alone than those with distant recurrence alone (10.4 vs. 5.0 months, P¼0.002) or those with both loco- and distant recurrences (10.4 vs. 5.8 months, P¼0.044); the survival for patients with distant recurrence alone or with both patterns was identical. Patients with early recurrence had a significantly poorer SAR than those with late recurrence (median, 5.5 vs. 9.0 months, P¼0.001). Logistic regression analysis revealed that positive resection margin (P¼0.001, HR¼14.532; 95%CI 7.399-38.466), early T stage (P¼0.018, HR¼0.014; 95%CI 0.000-0.475) and large tumor size (P¼0.030, HR¼4.345; 95%CI 1.152-16.391) were the determinant factors directly related to loco-recurrence alone. Conclusions: Patients with PDAC loco-recurrence alone had a significantly better SAR than those with distant recurrence. Adjuvant chemoradiotherapy should be considered to reduce loco-recurrence further and improve long-term survival.
J.M. Teleki, D.A. Gontsaruyk, T.M. Khristich, O.J. Olinyk. Bukovynian State Medical University, Chernivtsi, Ukraine Introduction: Quality of life is one of the important indicators of adaptation abilities in patients (including those with chronic pancreatitis (CP)) to the social conditions of life. The purpose of the study: To study features of the quality of life (QoL) in patients with CP. Materials and methods: 32 CP patients in the acute stage at the age of 29 to 61 years (men - 21 women - 11) were examined. The diagnosis was verified on the basis of a thorough medical history, objective methods of research, laboratory, ELISA and instrumental data. QoL was assessed using the SF-36 test «Health Status Survey» which 100 points represents full health. The results were compared with the control group (20 almost healthy persons). Results: In patients with CP significantly reduced physical and role functioning (67,5 8,2 points and 32,9 9,2, respectively) compared with the control group (96,3 2,4 and 87,5 7,5). Vital activity was limited to 47,0 10,4 points, while in almost healthy it amounted to 77,5 4,2 points. Sleep disturbance was recorded at 45.6% and 43.7% poor coping with stress. Conclusion: These data confirm the particular violations of the quality of life during exacerbation of CP that must be considered in therapeutic practice.
P65. Loco-recurrence after resection for ductal adenocarcinoma of the pancreas: Predictors and implications for adjuvant chemoradiotherapy A.E. Frampton 1, Y. Zhang 1, C. Kyriakides 1, J.J. Bong 1, N.A. Habib 1, R. Ahmad 2, L.R. Jiao 1. 1 HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK 2 Dept. of Histopathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
Abstract Introduction: Loco (regional) recurrence rate after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains high and the efficiency of adjuvant chemoradiotherapy is still debated.
P66. Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma A.E. Frampton 1, Y. Zhang 1, P. Cohen 2, C. Kyriakides 1, J.J. Bong 1, N.A. Habib 1, D.R. Spalding 1, R. Ahmad 2, L.R. Jiao 1. 1
HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, United Kingdom 2 Dept. of Histopathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
Abstract Introduction: The relevance of R1 (microscopic tumor involvement) status in different surgical resection margins (RMs) after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated. Aims/objectives: To assess the rates of R1 resection in different RMs and analyse their prognostic influence on survival. Patients and methods: Data for patients who underwent PD (n¼258) in our hospital between January 2001-December 2010 were retrieved from a prospective database. Using our standardized pathological reporting protocol, the circumferential resection margin is distinguished as 4 RMs: pancreatic transection, medial, posterior and anterior surfaces. Results: A total of 84 patients were included with a median age of 63.7 years (range, 40.7–79.5 years). R1 rate was 57.1% (48/84) at all margins, 31.0% (26/84) in anterior margin, 42.9% (36/84) in posterior margin, 29.8% (25/84) in medial margin, and 7.1% (3/84) in pancreatic transection margin. The median overall and disease-free survival for all R1 resections were significantly poorer than those for R0 resection (17.2 vs. 28.7 months, P¼0.007; and 12.3 vs. 21.0 months, P¼0.019). Only medial margin positivity had a significant impact on survival (13.8 vs. 28.0 months, P <0.001), as opposed to anterior margin (19.7 vs. 23.3 months, P¼0.187) and posterior margin (17.5 vs. 24.2 months, P¼0.104) involvement. Multivariate analysis showed that medial margin R0 status was an independent prognostic factor (P¼0.002, HR¼0.381; 95% CI 0.207-0.701). Conclusions: With a standardized pathological reporting protocol, the medial surgical RM is the most important margin in PD for PDAC and a R1 resection here predicts poor survival.