Management of periampullary XXXX by pancreaticoduodenectomy at a regional teaching hospital.

@entity1 @entity201 @entity420 @entity6029 @entity1349
BACKGROUND: @entity420 ( @entity420 ) includes: pancreatic, duodenal and @entity420 ; and @entity201 . Pancreaticoduodenectomy (PD) is required for cure of @entity420 . Previous studies demonstrated the likelihood of cure increases when a microscopically negative (R0) margin is achieved. Clearance of the @entity6029 ( @entity6029 ) margin has been identified as the most critical margin in PD. Some authors have emphasized the importance of certain techniques to clear the @entity6029 margin. Neither the degree to which these techniques have been incorporated nor their impact on margin status and survival has been described. We hypothesized that use of techniques focusing on clearing the @entity6029 margin would result in higher R0 resection rates and improved survival after PD in @entity1 with @entity420 . METHODS: A retrospective study was performed on @entity1 from 1/1/1985 until 7/31/2007. Data on @entity1 demographics, clinical presentation, preoperative treatment, operative technique, margins, and postoperative outcomes were collected. Ninety-three @entity1 were identified for inclusion in the study. Three approximately equal groups were created for analysis. RESULTS: The @entity1349 ( @entity1349 ) for the entire cohort was 19 months and was not different among the groups studied. Margins were microscopically negative in 81% of cases. The percentage of node-positive cases increased during the time period, as did the number of lymph nodes (LNs) examined (P=0.017). The use of pylorus-preserving PD decreased (P=0.001) while resection of the superior mesenteric/portal vein (SMV/PV) increased during the study period. We observed an increase in descriptions of the clearance of the anterior aspect of the aorta and inferior vena cava (IVC), dissection to the right side of the @entity6029 , dissection to the origin of the @entity6029 and intra-operative identification of the @entity6029 margin. Dissecting to the @entity6029 did not change the likelihood of achieving an R0 margin. @entity1349 was improved after R0 resections (R0: 21 months vs. R1/2: 10 months) but this difference was not statistically significant (P=0.099). There was no association between margin status and @entity1349 . Changes in the pathology reporting of margins were observed, with statistically significant increases in the percentage of cases in which the @entity6029 , common bile duct and pancreatic neck margins were separately reported. However, the @entity6029 margin was separately reported in only 26% of pathology reports. CONCLUSIONS: The operative techniques used in PD at this institution have changed over time. The increasing frequency of dissection to the @entity6029 and identification of the @entity6029 margin by both surgeon and pathologist suggest an increased attention to the @entity6029 margin. This shift did not result in significant improvements in survival or margin status, but it is consistent with the recognition of the importance of the @entity6029 margin. Our analysis has also identified areas of potential improvement in the ways in which operative and pathology reports for PD are generated.
