Pancreatic Cancer Frequently Infiltrates the TRIANGLE Compartment: A Surgical Option to Prevent Local Recurrence

Area of Science:

• Surgical Oncology
• Gastrointestinal Pathology
• Pancreatic Cancer Research

Background:

• Locoregional recurrence affects approximately 30% of patients post-pancreatic ductal adenocarcinoma (PDAC) resection.
• The TRIANGLE compartment is a common site for recurrence, yet often not addressed in standard resections.
• Surgical strategies targeting the TRIANGLE compartment aim to improve local disease control.

Purpose of the Study:

• To evaluate the presence of pancreatic cancer cells within the TRIANGLE compartment.
• To determine the TRIANGLE compartment's role in locoregional recurrence of PDAC.

Main Methods:

• Prospective study of 131 patients undergoing TRIANGLE compartment resection for PDAC.
• Histopathological analysis of lymph nodes, perineural, adipose, and lymphovascular tissues within the compartment.
• Comparison of cancer-positive (Tr+) and cancer-negative (Tr-) TRIANGLE patients.

Main Results:

• Malignant cells were detected in the TRIANGLE compartment in 41 patients (31%).
• Cancer cell presence varied by tumor stage: 56% in locally advanced, 40% in borderline resectable, and 21% in resectable PDAC.
• Neoadjuvant chemotherapy was administered to 43% of patients.

Conclusions:

• The TRIANGLE compartment harbors cancer cells in approximately one-third of PDAC patients.
• This finding may elucidate the high rates of locoregional recurrence after standard pancreatic resections.
• Incorporating TRIANGLE compartment resection into PDAC management could enhance local disease control.