Impact of resection margin status on recurrence and survival in pancreatic cancer surgery

Abstract

Background The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is poor and selection of patients for surgery is challenging. This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics and/or technical factors associated with a positive resection margin in patients with PDAC. Methods Patients scheduled for pancreatic resection for PDAC between 2006 and 2016 were identified from an institutional database. The effect of resection margin status, patient characteristics and tumour characteristics on LRR, distant metastasis and OS was assessed. Results A total of 322 patients underwent pancreatectomy for PDAC. A positive resection (R1) margin was found in 129 patients (40·1 per cent); this was associated with decreased OS compared with that in patients with an R0 margin (median 15 (95 per cent c.i. 13 to 17) versus 22 months; P < 0·001). R1 status was associated with reduced time to LRR (median 16 versus 36 (not estimated, n.e.) months; P = 0·002). Disease recurrence patterns were similar in the R1 and R0 groups. Risk factors for early recurrence were tumour stage, positive lymph nodes (N1) and perineural invasion. Among 100 patients with N0 disease, R1 status was associated with shorter OS compared with R0 resection (median 17 (10 to 24) versus 45 (n.e.) months; P = 0·002), whereas R status was not related to OS in 222 patients with N1 disease (median 14 (12 to 16) versus 17 (15 to 19) months after R1 and R0 resection respectively; P = 0·068). Conclusion Although pancreatic resection with a positive margin was associated with poor survival and early recurrence, particularly in patients with N1 disease, disease recurrence patterns were similar between R1 and R0 groups.

Pancreatic cancer: An update on diagnosis and management

“…11,12 The remaining 30% present with disease that interfaces with major vascular structures, making it either borderline resectable or locally advanced (stage 3). Metastases most commonly are to lymph nodes outside standard lymphadenectomy stations, peritoneum, liver and lungs, and may be identified by CT. 13 Magnetic resonance imaging is more accurate for characterising indeterminate liver lesions. 14 Positron emission tomography (PET)/CT is increasingly being used to determine staging and may change the treatment plan for up to 20% of patients.…”

Pancreatic resection in patients with synchronous extra‐pancreatic malignancy: outcomes and complications

“…In this study, we summarize the experience of a tertiary institution in the management of patients diagnosed with a resectable pancreatic tumour and a concurrent primary extra‐pancreatic malignancy. Ten patients underwent pancreatic resections under these circumstances, with minimal morbidity, no 90‐day mortality and long‐term survival rates comparable to, or more favourable than, patients diagnosed with a pancreatic malignancy without the presence of a synchronous extra‐pancreatic tumour . Eight patients remained alive, with a median follow‐up period of 41.3 months.…”

“…Ten patients underwent pancreatic resections under these circumstances, with minimal morbidity, no 90-day mortality and long-term survival rates comparable to, or more favourable than, patients diagnosed with a pancreatic malignancy without the presence of a synchronous extra-pancreatic tumour. 19,20 Eight patients remained alive, with a median follow-up period of 41.3 months. Of these patients, six underwent pancreatic resections for a PDAC.…”

Author response to: Resection margin status in pancreatic cancer surgery: is it really less important than the N status?

“…We appreciate the interest of Fiorillo et al . in our study and thank them for their comments. Indeed, the results of our study showed that patients with N0 disease had significantly worse survival after R1 compared with R0 resection and comparable survival in N1 disease.…”