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Pancreas tail adenocarcinoma tumor size is highly predictive of positive margins after a nonradical resection

  • Author Footnotes
    1 Co-authors.
    Lina Cadili
    Correspondence
    Corresponding author. Department of Surgery, University of British Columbia, 5th Floor, 2775 Laurel St. Vancouver, BC, V5Z 1M9, USA.
    Footnotes
    1 Co-authors.
    Affiliations
    Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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  • Author Footnotes
    1 Co-authors.
    Elizaveta Vasilyeva
    Footnotes
    1 Co-authors.
    Affiliations
    Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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  • Jennifer Li
    Affiliations
    Division of Liver and Pancreas Transplantation, University of California Los Angeles, Los Angeles, CA, USA
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  • Peter Kim
    Affiliations
    Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada

    Hepatopancreatobiliary and Liver Transplant Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Stephen Chung
    Affiliations
    Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada

    Hepatopancreatobiliary and Liver Transplant Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Maja Segedi
    Affiliations
    Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada

    Hepatopancreatobiliary and Liver Transplant Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Author Footnotes
    1 Co-authors.

      Highlights

      • Positive margins signify poor tumor biology.
      • Tumors over 4 cm in the tail are associated with positive margins.
      • Tumors in the body are associated with positive margins regardless of size.

      Abstract

      Background

      Radical resection (RAMPS) of left sided pancreatic ductal adenocarcinoma (PDAC) is effective in achieving R0 margins; however, not universally accepted due to lack of improved survival. We hypothesized that only larger tumors lead to R1 in non-RAMPS procedures.

      Methods

      A retrospective review of charts between 2008 and 2020 was performed. The primary outcome was evaluating R0 resection based on left-sided tumors’ size and location, and secondary outcomes were OS and DFS.

      Results

      Sixty-eight percent had R0 resection. R1 groups’ tumors were larger (5.5 cm vs. 3.8 cm, p = 0.004) and had higher LVI involvement (p = 0.003). OS and DFS did not differ on multivariate analysis. Tumor size above 4 cm in the tail was associated with R1 (p = 0.01).

      Conclusions

      Larger tumors in the tail, but not body were associated with R1, but not worse survival. Perhaps larger tumors in the tail are a surrogate marker of poor disease biology.

      Keywords

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