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Tumour origin and R1 rates in pancreatic resections: towards consilience in pathology reporting

  • Munita Bal
  • Swapnil Rane
  • Sanjay Talole
  • Mukta Ramadwar
  • Kedar Deodhar
  • Prachi Patil
  • Mahesh Goel
  • Shailesh Shrikhande
Original Article
  • 19 Downloads

Abstract

To evaluate differences in the R1 rates of ampullary (AC), pancreatic (PC), and distal bile duct (DBD) cancers in pancreatoduodenectomies (PD) using standardised pathology assessment. Data of PD (2010–2011) analysed in accordance with the Royal College of Pathologists (UK) protocol, were retrieved. Clinicopathologic features, including frequency, topography, and mode of margin involvement in AC (n = 87), PC (n = 18), and DBD (n = 5) cancers were evaluated. The R1 rate was 7%, 67%, and 20% in the AC, PC, and DBD cancers (p < 0.001). Within the PC cohort, R1 rate was heterogeneous (chemo-naïve, 77%; post-neoadjuvant, 40%). Commonest involved margins were as follows: posterior in overall PD (35%), AC (43%), overall PC (33%), and post-neoadjuvant PC (100%); superior mesenteric artery margin in chemo-naïve PC (38%) and common bile duct margin in DBD (100%) cancers. In AC, majority (66%) of R1 were signet ring cell type. Indirect margin involvement due to tumour within lymph node, perineural sheath or lymphovascular space was observed in 26% cases, and altered R1 rate in AC, PC, and DBD cohorts by 1%, 12%, and 0%, respectively. Although not statistically significant, patients with R1 had lower disease-free survival than those with R0 (mean, 25.4 months versus 44.4 months). Tumour origin impacts R1 data in PD necessitating its accurate classification by pathologists. Indirect involvement, histology, and neoadjuvant therapy influence the R1 rate, albeit in a minority of cases. Generating cogent R1 data based on standardised pathology reporting is the foremost need of the hour.

Keywords

Resection margin R1 rate Pancreatoduodenectomy Tumour origin Standardised pathology evaluation protocol 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical responsibilities of authors’ section

All individuals listed as co-authors of the manuscript qualify for every one of the four criteria listed in the ICMJE recommendation for qualification of authorship.

Supplementary material

428_2018_2429_MOESM1_ESM.docx (50 kb)
ESM 1 (DOCX 50 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PathologyTata Memorial CentreMumbaiIndia
  2. 2.Department of Epidemiology and StatisticsTata Memorial CentreMumbaiIndia
  3. 3.Department of Digestive Diseases and NutritionTata Memorial CentreMumbaiIndia
  4. 4.Department of Surgical OncologyTata Memorial CentreMumbaiIndia

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