The impact of vascular margin invasion on local recurrence after pancreatoduodenectomy in pancreatic adenocarcinoma

TL;DR

This study shows that arterial margin invasion in pancreatic cancer surgery is strongly linked to local recurrence, suggesting preoperative treatments may help reduce this risk.

Contribution

The study specifically identifies arterial margin invasion as a significant predictor of local recurrence after pancreatoduodenectomy.

Findings

Arterial margin invasion was significantly associated with local recurrence (HR 2.70, p = 0.031).

Time to local recurrence was shorter when margins were affected, especially in the arterial margin (13.7 vs 32.1 months).

Positive arterial margins remained a significant predictor of local recurrence in multivariate analysis.

Abstract

Pancreatic ductal adenocarcinoma (PADC) still has nowadays a very impaired long-term survival. Most studies are focused on overall survival; however, local recurrence occurs about up to 50% of cases and seems to be highly related with margin resection status. We aim to analyze the impact of vascular resection margins on local recurrence (LR) and to assess its impact on overall and disease-free survival.

Eighty out of 191 patients who underwent pancreatoduodenectomy in a university hospital between 2006 and 2021 with PDAC diagnosis were analyzed and vascular margin status specifically addressed. Univariate and multivariate were performed. Time to LR was compared by using the Kaplan–Meier method and prognostic factors assessed using Cox regression hazards model.

LR appeared in 10 (50%) of the overall R1 resections in the venous margin and 9 (60%) in the arterial one. Time to LR was significantly shorter when any margin was overall affected (23.2 vs 44.7 months, p = 0.01) and specifically in the arterial margin involvement (13.7 vs 32.1 months, p = 0.009). Overall R1 resections (HR 2.61, p = 0.013) and a positive arterial margin (HR 2.84, p = 0.012) were associated with local recurrence on univariate analysis, whereas arterial positive margin remained significant on multivariate analysis (HR 2.70, p = 0.031).

Arterial margin invasion is correlated in our cohort with local recurrence. Given the limited ability to modify this margin intraoperatively, preoperative therapies should be considered to improve local margin clearance.

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