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  • Title: Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival.
    Author: Fatima J, Schnelldorfer T, Barton J, Wood CM, Wiste HJ, Smyrk TC, Zhang L, Sarr MG, Nagorney DM, Farnell MB.
    Journal: Arch Surg; 2010 Feb; 145(2):167-72. PubMed ID: 20157085.
    Abstract:
    OBJECTIVE: To assess the effect of R0 resection margin status and R0 en bloc resection in pancreatoduodenectomy outcomes. DESIGN: Retrospective medical record review. SETTING: Mayo Clinic, Rochester, Minnesota. PATIENTS: Patients who underwent pancreatoduodenectomy for pancreatic adenocarcinoma at our institution between January 1, 1981, and December 31, 2007, were identified and their medical records were reviewed. MAIN OUTCOME MEASURE: Median survival times. RESULTS: A total of 617 patients underwent pancreatoduodenectomy. Median survival times after R0 en bloc resection (n = 411), R0 non-en bloc resection (n = 57), R1 resection (n = 127), and R2 resection (n = 22) were 19, 18, 15, and 10 months, respectively (P < .001). A positive resection margin was associated with death (P = .01). No difference in survival time was found between patients undergoing R0 en bloc and R0 resections after reexcision of an initial positive margin (hazard ratio, 1.19; 95% confidence interval, 0.87-1.64; P = .28). CONCLUSIONS: R0 resection remains an important prognostic factor. Achieving R0 status by initial en bloc resection or reexcision results in similar long-term survival.
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