How to prevent local recurrence in pancreatic cancer surgery?
Autores
Vera Oliveira, Lucia Carvalho, Mireia Castillo-Martin, Rafaela Lima Rego, Elsa Francisco, Filipe Borges, Christoph Berchtold, Arianeb Merabi, Gil Gonçalves, Markus W. Buchler
Resumo Introdução
Local recurrence rates after pancreatic cancer surgery have been shown to reach 30-50%. This disappointing figure indicates that the current surgical approach may not be the right oncologic procedure. We hypothesized that the soft tissue in the TRIANGLE formed by the CT, SMA and SMV is infiltrated by cancer cells. If this tissue is not removed during surgery, it may be responsible for local recurrence/persistence of cancer. We present the first-time cancer infiltration rates of the TRIANGLE compartment.
Resumo Métodos
Using standard pathohistological methods, the TRIANGLE compartment (Tr) was analyzed for the presence of cancer cells in the lymph nodes (LN), lymph vessels, neural tissue, and fat tissue.
Resumo Resultados
Between 2023-2024, 145 patients underwent pancreatic cancer surgery; 85 of them had a Triangle operation. In 25 patients (29%), the Tr tissue was cancer-positive: 10 LN, 13 fat tissue, 9 neural invasion, and 6 lymphovascular invasion. 40% had more than 1 place positive for cancer. Tr+ patients had larger tumors,higher N stages and grades Global morbidity (Clavien-Dindo - III) and mortality was 32% and 1% Hospital stay was 12 days
Resumo Discussão
We provide new findings about the radicality of pancreatic cancer surgery, demonstrating that TRIANGLE tissue compartment, which is not part of standard surgical resection, might be responsible for most local recurrences. This suggests a need to redefine these recurrences as local persistence and to develop a NEW standard of surgical approach to pancreatic cancer.