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Standardization of Surgical and Pathologic Variables is Needed in Multicenter Trials of Adjuvant Therapy for Pancreatic Cancer: Results from the ACOSOG Z5031 Trial

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Standardization of surgical and pathologic techniques is crucial to the interpretation of studies evaluating adjuvant therapies for pancreatic cancer (PC).

Methods

To assess the degree to which treatment administered prior to enrollment of patients in trials of adjuvant therapy is quality controlled, the operative and pathology reports of patients in American College of Surgeons Oncology Group (ACOSOG) Z5031—a national trial of chemoradiation following pancreaticoduodenectomy (PD)—were rigorously evaluated. We analyzed variables with the potential to influence staging or outcome.

Results

80 patients reported to have undergone R0 (75%) or R1 (25%) pylorus-preserving (38%) or standard (62%) PD were evaluated. A search for metastases was documented in 96% of cases. The proximity of the tumor to the superior mesenteric vein was reported in 69%; vein resection was required in 9% and lateral venorrhaphy in 14%. The method of dissection along the superior mesenteric artery (SMA) was described in 68%, being ultrasonic dissection (17%), stapler (24%), and clamp and cut (59%). SMA skeletonization was described in 25%, and absence of disease following resection was documented in 24%. The surgeon reported marking the critical SMA margin in 25%; inking was documented in 65% of cases and evaluation of the SMA margin was reported in 47%. A range of 1–49 lymph nodes was evaluated. Only 34% of pathology reports met College of American Pathologists criteria.

Conclusions

Trials of adjuvant therapy following PD suffer from a lack of standardization and quality control prior to patient enrollment. These data suggest areas for improvement in the design of multidisciplinary treatment protocols.

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Acknowledgment

Supported by funding from the US National Institutes of Health to the American College of Surgeons Oncology Group, grant U10 CA 76001.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Matthew H. G. Katz MD & Peter W. T. Pisters MD

  2. Division of Surgical Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA

    Nipun B. Merchant MD

  3. Department of Surgery, Anderson Cancer Institute, Memorial University Medical Center, Savannah, GA, USA

    Steven Brower MD

  4. Division of Health Sciences Research, The Mayo Clinic, Rochester, MN, USA

    Megan Branda MD

  5. Division of Surgical Oncology, The University of Chicago Medical Center, Chicago, IL, USA

    Mitchell C. Posner MD

  6. Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    L. William Traverso MD

  7. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA

    Ross A. Abrams MD

  8. Department of Medical Oncology, Virginia Mason Medical Center, Seattle, WA, USA

    Vincent J. Picozzi MD

Authors
  1. Matthew H. G. Katz MD
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  2. Nipun B. Merchant MD
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  3. Steven Brower MD
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  4. Megan Branda MD
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  5. Mitchell C. Posner MD
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  6. L. William Traverso MD
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  7. Ross A. Abrams MD
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  8. Vincent J. Picozzi MD
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  9. Peter W. T. Pisters MD
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The American College of Surgeons Oncology Group

Corresponding author

Correspondence to Matthew H. G. Katz MD.

Additional information

This study was conducted for the American College of Surgeons Oncology Group.

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Katz, M.H.G., Merchant, N.B., Brower, S. et al. Standardization of Surgical and Pathologic Variables is Needed in Multicenter Trials of Adjuvant Therapy for Pancreatic Cancer: Results from the ACOSOG Z5031 Trial. Ann Surg Oncol 18, 337–344 (2011). https://doi.org/10.1245/s10434-010-1282-y

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  • DOI: https://doi.org/10.1245/s10434-010-1282-y

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