Nationwide Impact of Centralization, Neoadjuvant Therapy, Minimally Invasive Surgery, and Standardized Pathology Reporting on R0 Resection and Overall Survival in Pancreatoduodenectomy for Pancreatic Cancer

Simone Augustinus*, Pascale J.M. Schafrat, the Dutch Pancreatic Cancer Group, Boris V. Janssen, Bert A. Bonsing, Lodewijk A.A. Brosens, Olivier R. Busch, Stijn Crobach, Michail Doukas, Casper H. van Eijck, Lydia G.M. van der Geest, Bas Groot Koerkamp, Ignace H.J.T. de Hingh, G. Mihaela Raicu, Hjalmar C. van Santvoort, Marie Louise van Velthuysen, Joanne Verheij, Marc G. Besselink*, Arantza Farina Sarasqueta*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
14 Downloads (Pure)

Abstract

Background: Surgeons aim for R0 resection in patients with pancreatic cancer to improve overall survival. However, it is unclear whether recent changes in pancreatic cancer care such as centralization, increased use of neoadjuvant therapy, minimally invasive surgery, and standardized pathology reporting have influenced R0 resections and whether R0 resection remains associated with overall survival. Methods: This nationwide retrospective cohort study included consecutive patients after pancreatoduodenectomy (PD) for pancreatic cancer from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Database (2009–2019). R0 resection was defined as > 1 mm tumor clearance at the pancreatic, posterior, and vascular resection margins. Completeness of pathology reporting was scored on the basis of six elements: histological diagnosis, tumor origin, radicality, tumor size, extent of invasion, and lymph node examination. Results: Among 2955 patients after PD for pancreatic cancer, the R0 resection rate was 49%. The R0 resection rate decreased from 68 to 43% (2009–2019, P < 0.001). The extent of resections in high-volume hospitals, minimally invasive surgery, neoadjuvant therapy, and complete pathology reports all significantly increased over time. Only complete pathology reporting was independently associated with lower R0 rates (OR 0.76, 95% CI 0.69–0.83, P < 0.001). Higher hospital volume, neoadjuvant therapy, and minimally invasive surgery were not associated with R0. R0 resection remained independently associated with improved overall survival (HR 0.72, 95% CI 0.66–0.79, P < 0.001), as well as in the 214 patients after neoadjuvant treatment (HR 0.61, 95% CI 0.42–0.87, P = 0.007). Conclusions: The nationwide rate of R0 resections after PD for pancreatic cancer decreased over time, mostly related to more complete pathology reporting. R0 resection remained associated with overall survival.

Original languageEnglish
Pages (from-to)5051-5060
Number of pages10
JournalAnnals of Surgical Oncology
Volume30
Issue number8
DOIs
Publication statusPublished - Aug 2023

Bibliographical note

Funding Information:
This project was supported by Deltaplan Alvleesklierkanker (Grant No. 201-078 WOO 21-01).

Publisher Copyright:
© 2023, The Author(s).

Fingerprint

Dive into the research topics of 'Nationwide Impact of Centralization, Neoadjuvant Therapy, Minimally Invasive Surgery, and Standardized Pathology Reporting on R0 Resection and Overall Survival in Pancreatoduodenectomy for Pancreatic Cancer'. Together they form a unique fingerprint.

Cite this