Acta Scientific Gastrointestinal Disorders

Editorial Volume 8 Issue 12

Flood Syndrome

Zain Majid1* and Hassaan Yousuf2

1Department of Gastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
2Sindh Medical College, Pakistan

*Corresponding Author: Zain Majid, Department of Gastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan.

Received: November 17, 2025; Published: November 20, 2025

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Abstract

Introduction: Pancreaticoduodenectomy (PD) is the primary curative treatment for periampullary and pancreatic head malignancies. A tumor-free resection margin (R0) is a critical prognostic factor, yet overall survival remains poor. This study aimed to assess overall survival after PD, identify histopathological factors predictive of positive margins, and compare survival between margin-positive and margin-negative patients.

Methods: A retrospective review of a prospectively maintained database was conducted for patients undergoing PD for malignant disease at a tertiary institution from January 2017 to June 2022. Patients with an ECOG status ≤2 were included, while those with benign disease, intraoperative metastases, or palliative procedures were excluded. Standard preoperative imaging was used for resectability assessment. Data on demographics, histopathology, and survival were analyzed using univariate analysis and Kaplan-Meier survival curves.

Results: Of 75 patients who underwent curative resection, 66 were included in the final survival analysis. The margin positivity rate was 10.8%. The most common site of margin involvement was the superior mesenteric artery (SMA) margin. Factors significantly associated with a positive resection margin were higher T-stage (T3) and the presence of perineural invasion (PNI). The mean overall survival was significantly lower in the margin-positive group compared to the margin-negative group (6.0 ± 1.5 months vs. 29.0 ± 2.8 months, p = 0.0004). The overall mean survival for the entire cohort was 26.9 months.

Conclusion: A positive resection margin following pancreaticoduodenectomy is associated with significantly worse overall survival and is strongly linked to advanced T-stage and perineural invasion. However, the dismal survival even in margin-negative patients underscores the aggressive biology of these tumors. Future efforts should focus on better understanding tumor biology, refining surgical approaches, and developing more effective adjuvant therapies.

Keywords: Pancreaticoduodenectomy; Resection Margin; Overall Survival; Perineural Invasion; Pancreatic Neoplasms

References

  1. Kawai M., et al. “Artery-first approach for pancreaticoduodenectomy”. Journal of Hepato-Biliary-Pancreatic Sciences 6 (2018): 319-320.
  2. Obonyo D., et al. “The impact of resection margin distance on survival and recurrence in pancreatic ductal adenocarcinoma in a retrospective cohort analysis”. PLOS ONE2 (2023): e0281921.
  3. Pandanaboyana S., et al. “Artery first approach to pancreatoduodenectomy: current status”. ANZ Journal of Surgery3 (2016): 127-132.
  4. van Roessel S., et al. “Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center”. Annals of Surgical Oncology6 (2018): 1760-1767.
  5. Liu DN., et al. “Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma”. Oncotarget 5 (2017): 7766-7776.
  6. Butler JR., et al. “A systematic review of the role of periadventitial dissection of the superior mesenteric artery in affecting margin status after pancreatoduodenectomy for pancreatic adenocarcinoma”. HPB 4 (2016): 305-311.
  7. Pugalenthi A., et al. “Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma”. Journal of Surgical Oncology2 (2016): 188-193.
  8. Delpero JR., et al. “Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens”. HPB 1 (2014): 20-33.
  9. Greco SH., et al. “Neoadjuvant therapy is associated with lower margin positivity rates after Pancreaticoduodenectomy in T1 and T2 pancreatic head cancers: An analysis of the National Cancer Database”. Surgery Open Science 3 (2020): 22-28.
  10. Mathur A., et al. “Margin Status Impacts Survival after Pancreaticoduodenectomy but Negative Margins Should Not be Pursued”. American Surgery4 (2014): 353-360.
  11. Zhang Y., et al. “Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma”. Journal of Gastrointestinal Surgery10 (2012): 1875-1882.
  12. Pine JK., et al. “Prospective assessment of resection margin status following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma after standardisation of margin definitions”. Pancreatology3 (2020): 537-544.
  13. Tummers WS., et al. “Impact of resection margin status on recurrence and survival in pancreatic cancer surgery”. British Journal of Surgery 8 (2019): 1055-1065.
  14. Schorn S., et al. “The influence of neural invasion on survival and tumor recurrence in pancreatic ductal adenocarcinoma - A systematic review and meta-analysis”. Surgical Oncology1 (2017): 105-515.
  15. Stopczynski RE., et al. “Neuroplastic changes occur early in the development of pancreatic ductal adenocarcinoma”. Cancer Research 6 (2014): 1718-1727.
  16. Bo Li., et al. “Risk factors of positive resection margin differ in pancreaticoduodenectomy and distal pancreatosplenectomy for pancreatic ductal adenocarcinoma undergoing upfront surgery”. Asian Journal of Surgery 4 (2023): 1541-1549.
  17. Quero G., et al. “Resection Margin Status and Long-Term Outcomes after Pancreaticoduodenectomy for Ductal Adenocarcinoma: A Tertiary Referral Center Analysis”. Cancers 16 (2024): 2347.
  18. “Anti-Aging Genes Improve Appetite Regulation and Reverse Cell Senescence and Apoptosis in Global Populations”. Advances in Aging Research 5 (2016): 9-26.
  19. “Single Gene Inactivation with Implications to Diabetes and Multiple Organ Dysfunction Syndrome”. Journal of Clinical Epigenetics 3 (2017): 24.
  20. “Nutrition Therapy Regulates Caffeine Metabolism with Relevance to NAFLD and Induction of Type 3 Diabetes”. Journal of Diabetes and Metabolic Disorders 4 (2017): 019.

Citation

Citation: Hitesh Sarda., et al. “Status of Resection Margin in Pancreaticoduodenectomy: Is there Real Impact on Patient Survival?".Acta Scientific Gastrointestinal Disorders 8.12 (2025): 03-09.

Copyright

Copyright: © 2025 Hitesh Sarda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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