Meta-analysis of radical resection rates and margin assessment in pancreatic cancer

Chandrasegaram, M. D., Goldstein, D., Simes, J., Gebski, V., Kench, J. G., Gill, A. J., Samra, J. S., Merrett, N. D., Richardson, A. J. and Barbour, A. P. (2015) Meta-analysis of radical resection rates and margin assessment in pancreatic cancer. British Journal of Surgery, 102 12: 1459-1472. doi:10.1002/bjs.9892


Author Chandrasegaram, M. D.
Goldstein, D.
Simes, J.
Gebski, V.
Kench, J. G.
Gill, A. J.
Samra, J. S.
Merrett, N. D.
Richardson, A. J.
Barbour, A. P.
Title Meta-analysis of radical resection rates and margin assessment in pancreatic cancer
Journal name British Journal of Surgery   Check publisher's open access policy
ISSN 0007-1323
1365-2168
Publication date 2015-11-01
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/bjs.9892
Open Access Status Not Open Access
Volume 102
Issue 12
Start page 1459
End page 1472
Total pages 14
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley and Sons
Collection year 2016
Language eng
Formatted abstract
Background
R0 resection rates (complete tumour removal with negative resection margins) in pancreatic cancer are 70–80 per cent when a 0-mm margin is used, declining to 15–24 per cent with a 1-mm margin. This review evaluated the R0 resection rates according to different margin definitions and techniques.

Methods
Three databases (MEDLINE from 1946, PubMed from 1946 and Embase from 1949) were searched to mid-October 2014. The search terms included ‘pancreatectomy OR pancreaticoduodenectomy’ and ‘margin’. A meta-analysis was performed with studies in three groups: group 1, axial slicing technique (minimum 1-mm margin); group 2, other slicing techniques (minimum 1-mm margin); and group 3, studies with minimum 0-mm margin.

Results
The R0 rates were 29 (95 per cent c.i. 26 to 32) per cent in group 1 (8 studies; 882 patients) and 49 (47 to 52) per cent in group 2 (6 studies; 1568 patients). The combined R0 rate (groups 1 and 2) was 41 (40 to 43) per cent. The R0 rate in group 3 (7 studies; 1926 patients) with a 0-mm margin was 72 (70 to 74) per cent The survival hazard ratios (R1 resection/R0 resection) revealed a reduction in the risk of death of at least 22 per cent in group 1, 12 per cent in group 2 and 23 per cent in group 3 with an R0 compared with an R1 resection. Local recurrence occurred more frequently with an R1 resection in most studies.

Conclusion
Margin clearance definitions affect R0 resection rates in pancreatic cancer surgery. This review collates individual studies providing an estimate of achievable R0 rates, creating a benchmark for future trials.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Medicine Publications
 
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