Survival Length after Pancreaticoduodenectomy for Adenocarcinoma in Correlation with Preoperative CT Characteristics and Tumour Resections Margin Assesment

Abstract

Background and Objectives: Pancreatic carcinoma is an aggressive tumour with a grim prognosis. The accuracy of staging is essential for indicating primary surgery in patients with borderline resectable tumours. The purpose of this paper was to study the possible correlation between the pre-operation characteristics of the tumour found on CT, the infiltration of the individual resection lines confirmed by a pathologist based upon the Leeds protocol, and the survival rate of patients with resectable pancreatic head ductal adenocarcinoma. Materials and Methods: The study involved patients operated on for pancreatic head adenocarcinoma which was clearly resectable based on the staging CT and intraoperative observation between 2011 and 2014. Only patients with an uncomplicated post-operation condition who underwent post-operation adjuvant chemotherapy were enrolled in the study. Results: In total 79 patients were assessed. The histological examination determined 16 patients (20.3 %) as R0 resection patients and 63 (79.7 %) as R1 resection patients. Patients with R1 positive resection line results had up to a 2.7 times higher risk of death than patients with R0 negative resection lines. There is an apparent trend of a higher mortality of patients with an increased relationship of the tumour to the superior mesenteric vein/portal vein (SMV/PV) wall in the pre-operation CT examination. Patients with a tumour interface between vein wall of up to 180° of circumference had up to a 1.97 times higher risk of death than patients without a tumour interface with the vein wall determined on the CT image (p = 0.131). Conclusion: The results confirmed the high occurrence of R1 resections even in the surgical treatment of clearly resectable pancreatic head tumours, and a statistically significantly reduced survival after R1 resection compared to R0 resection. A negative trend was found in the overall survival after pancreatic head tumour resection depending on the increasing interface between the tumour and the SMV/PV wall found on CT, but this result was not statistically significant.