Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma

• Published in: Oncotarget Vol. 8; no. 5; pp. 7766 - 7776
• Main Authors: Liu, Dao-Ning, Lv, Ang, Tian, Zhi-Hua, Tian, Xiu-Yun, Guan, Xiao-Ya, Dong, Bin, Zhao, Min, Hao, Chun-Yi
• Format: Journal Article
• Language: English
• Published: United States Impact Journals LLC 31.01.2017
• Subjects: Aged; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - secondary; Carcinoma, Pancreatic Ductal - surgery; Cell Movement; Disease Progression; Disease-Free Survival; Epithelial-Mesenchymal Transition; Female; Humans; Kaplan-Meier Estimate; Male; Margins of Excision; Mesenteric Artery, Superior - pathology; Mesenteric Artery, Superior - surgery; Middle Aged; Neoplasm Invasiveness; Neoplasm, Residual; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Research Paper; Risk Factors; Time Factors; Treatment Outcome; superior mesenteric artery margin; R0 surgery; epithelial–mesenchymal transition; pancreatic cancer; tumor budding
• ISSN: 1949-2553; 1949-2553
• DOI: 10.18632/oncotarget.13950

The aim of this study is trying to describe more details of superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, to evaluate biological and prognostic implications of tumor budding in this margin, and to provide more evidence for evaluation of R0 surgery in pancreaticoduodenectomy. 46 patients in 5-years period are included in this study. Immunochemistry and immunofluorescence are used to analyze tumor budding and epithelial-mesenchymal transition. Superior mesenteric artery margin might be described from four aspects including location, gross appearance, microscopic appearance and tumor budding. We find that 1mm rule for R1 surgery is more appropriate to predict prognosis (P = 0.009) than 0mm rule (P = 0.141). Expression of cytokeratin in tumor budding is significantly lower than primary tumor (P = 0.001), and it suggests that tumor budding may participate the procedure of epithelial-mesenchymal transition. High-grade tumor budding and decreasing cytokeratin of tumor budding correlate with distant metastasis and has negative influence on prognosis. So superior mesenteric artery margin might be not only an area that tumor cells may invade, but also a pathway for distant metastasis. It is necessary to evaluate superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic cancer.