Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocar'clnoma

In patients undergoing pancrealicoduodenectomy (PD) for pancreatic adenocarcinoma (PC), conversion to total pancreatectomy (TP) may be necessary to achieve RO resection. Hypothesis. We sought to examine the oncologic benefit of conversion of PD to TP to achieve an RO resection in patients with an isolated positive neck margin. Methods. We conducted a retrospective analysis of prospectively collected data at Indiana University and Johns Hopkins Medical Institutions. A review of 1,579 patients who underwent PD or TP for PC at these institutions between 1992 and 2006 was performed. Sixty-one patients were eligible. Results. Twenty-eight patients underwent PD with an isolated positive neck margin found on pathologic examination; 33 patients had conversion to TP for isolated neck margin involvement to achieve RO resection. Patients undergoing I P versus PD had a greater median survival (18 vs 10 months; P =.04). Mortality (6 % vs 7 %) and morbidity (36 % vs 54 %; P =.20) for TP versus PD were comparable. Multivariate analysis revealed PD and greater tumor size as the only independent predictors of poor long term survival (hazard ratio [HR], 2.2; P =.01 and HR, 1.3; P =.005). Conclusions. Conversion of PD to TP to achieve an RO resection in patients with pancreatic adenocarcinoma is associated with a survival benefit.