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Resection Margin Clearance in Pancreatic Cancer After Implementation of the Leeds Pathology Protocol (LEEPP): Clinically Relevant or Just Academic?

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Abstract

Background and objectives

The aim of this study was to assess the overall survival (OS) after R0/R1 resections in patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head after implementation of a standardized histopathologic protocol (Leeds Pathology Protocol, LEEPP).

Methods

One hundred and twenty-five patients underwent surgical resection because of PDAC of the pancreatic head. Patients were histopathologically examined according to a standardized protocol. Their oncologic outcome and clinicopathologic data were compared with those of a patient group before implementation of the LEEPP (n = 116).

Results

The R1 rate increased significantly from 13 to 52 %. There was no significant difference in OS between R0 and R1 resections. The median OS in patients with a tumor clearance of less than 2 mm from the resection margin was 15.1 months (12.1–18.1 months) versus 22.2 months (7.8–36.7 months) (P = 0.046). Multivariate analysis revealed a margin clearance or 2 mm and more as an independent prognosticator for OS.

Conclusions

With applying the LEEPP, there was still no significant correlation between the R-status and OS in patients with PDAC. However, since a margin clearance of 2 mm or more is a predictive factor for OS, the R1 definition might have to be adapted in PDAC.

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Conflict of interest

All contributing authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246, Hamburg, Germany

    Florian Gebauer, Michael Tachezy, Yogesh K. Vashist, Emre Yekebas, Jakob R. Izbicki & Maximilian Bockhorn

  2. Department of Pathology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany

    Andreas H. Marx

Authors
  1. Florian Gebauer
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  2. Michael Tachezy
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  3. Yogesh K. Vashist
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  4. Andreas H. Marx
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  5. Emre Yekebas
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  6. Jakob R. Izbicki
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  7. Maximilian Bockhorn
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Corresponding author

Correspondence to Florian Gebauer.

Additional information

Florian Gebauer and Michael Tachezy contributed equally to this work.

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Gebauer, F., Tachezy, M., Vashist, Y.K. et al. Resection Margin Clearance in Pancreatic Cancer After Implementation of the Leeds Pathology Protocol (LEEPP): Clinically Relevant or Just Academic?. World J Surg 39, 493–499 (2015). https://doi.org/10.1007/s00268-014-2808-4

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  • DOI: https://doi.org/10.1007/s00268-014-2808-4

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