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Original Article
The importance of assessing the SMA margin in patients undergoing pancreaticoduodenectomy
1 Department of Surgery, Methodist Richardson Medical Center, Dallas, TX, USA
2 University of North Texas Health Science Center, Fort Worth, TX, USA
3 Methodist Richardson Cancer Center, 2805 E. President George Busy Hwy, Richardson, TX, USA
Address correspondence to:
D. Rohan Jeyarajah
Methodist Richardson Cancer Center, 2805 E. President George Busy Hwy, Richardson, TX 75082,
USA
Message to Corresponding Author
Article ID: 100082Z04EC2019
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How to cite this article
Cho EE, Osman H, Dietemann D, Jeyarajah DR. The importance of assessing the SMA margin in patients undergoing pancreaticoduodenectomy. Int J Hepatobiliary Pancreat Dis 2019;9:100082Z04EC2019.ABSTRACT
Aim: The purpose of this study is to examine the true incidence of superior mesenteric artery (SMA) positivity in patients who have superior mesenteric vein (SMV) positivity while undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC).
Methods: All patients who underwent PD for PDAC between January 2005 and December 2011 were retrospectively identified from our database. Patients deemed resectable by NCCN guidelines, protocol CT scans, and endoscopic ultrasound were included. The PD specimen was inked using five colors to specifically identify and study the SMV and SMA margins. We also analyzed and compared R1-sub groups (R1A group- SMA and SMV positive; R1B group - SMV positive, SMA negative).
Results: 98 patients underwent PD for resectable pancreatic adenocarcinoma. 75 patients (76.5%) were found to have negative surgical margin on final pathology (R0 group) while 23 patients (23.4%) had positive SMV margins (R1 group). In the R1 group, 11 patients (47.8%) were found to have positive SMA margin (R1A group) and 12 patients were SMV positive and SMA negative (R1B group). No statistically significant survival difference was noted between R0 and R1 or between R1-A and R1-B.
Conclusion: This study demonstrates that with careful inking of the SMA and SMV margins, there is a high rate of concurrent SMA positivity in those patients that are SMV positive. There was no impact on survival. Accurate margin assessment is critical by careful examination and inking of the SMA and SMV margin.
Keywords: Margin positivity, Pancreatic cancer, Pancreaticoduodenectomy, Superior mesenteric
SUPPORTING INFORMATION
Author Contributions
Edward Eun Cho - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Houssam Osman - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Final approval of the version to be published
Daniel Dietemann - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Final approval of the version to be published
D. Rohan Jeyarajah - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Edward Eun Cho et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
