Can post-hoc video review of robotic pancreaticoduodenectomy predict portal/superior mesenteric vein margin status in pancreatic adenocarcinoma?

Jae P. Jung, Mazen S. Zenati, Ahmad Hamad, Melissa E. Hogg, Richard L. Simmons, Amer H. Zureikat, Herbert J. Zeh, Brian A. Boone

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Abstract

Background: Achieving margin negative resection is a significant determinant of outcome in pancreatic adenocarcinoma (PDA). However, because of the fibrotic nature of PDA, it can be difficult to discriminate fibrosis from active disease intra-operatively. We sought to determine if post-hoc video review of robotic pancreatico-duodenectomy (RPD) could predict the portal/superior mesenteric vein (PV/SMV) margin status on final pathology. Methods: Experienced pancreatic surgeons, blinded to patient and operative variables, reviewed the PV/SMV margin for available RPD videos of consecutive PDA patients from 9/2012 through 6/2017. Results: 107 RPD videos were reviewed. Of 76 patients (71%) predicted to have a negative vein margin on video review, 20 patients (26%) had a pathologic positive margin. 25 of 31 patients (81%) predicted to have positive margin on video review were positive on pathology. The specificity of video prediction was 90.3% with a sensitivity of 55.6% and an accuracy of 75.7%. Conclusion: Post-hoc video review prediction is unable to reliably predict a positive (R1) margin at the portal vein/SMV, suggesting that intra-operative clinical assessment may be suboptimal in determining the need for more extensive resections.

Original languageEnglish (US)
Pages (from-to)679-686
Number of pages8
JournalHPB
Volume21
Issue number6
DOIs
Publication statusPublished - Jun 2019

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ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Jung, J. P., Zenati, M. S., Hamad, A., Hogg, M. E., Simmons, R. L., Zureikat, A. H., ... Boone, B. A. (2019). Can post-hoc video review of robotic pancreaticoduodenectomy predict portal/superior mesenteric vein margin status in pancreatic adenocarcinoma? HPB, 21(6), 679-686. https://doi.org/10.1016/j.hpb.2018.10.012