Journal of Gastrointestinal Surgery

, Volume 16, Issue 10, pp 1875–1882 | Cite as

Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

  • Yaojun Zhang
  • Adam E. Frampton
  • Patrizia Cohen
  • Charis Kyriakides
  • Jan J. Bong
  • Nagy A. Habib
  • Duncan R. C. Spalding
  • Raida Ahmad
  • Long R. JiaoEmail author
Original Article



Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated.


Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed.


For PDAC, the R1 rate was 57.1 % (48/84) for any margin, 31.0 % (26/84) for anterior surface, 42.9 % (36/84) for posterior surface, 29.8 % (25/84) for medial margin, and 7.1 % (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17.2 vs. 28.7 months, P = 0.007 and 12.3 vs. 21.0 months, P = 0.019, respectively). For individual margins, only medial positivity had a significant impact on survival (13.8 vs. 28.0 months, P < 0.001), as opposed to involvement in the anterior (19.7 vs. 23.3 months, P = 0.187) or posterior margin (17.5 vs. 24.2 months, P = 0.104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0.002, HR = 0.381; 95 % CI 0.207–0.701).


The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.


Pancreatic ductal adenocarcinoma Pancreaticoduodenectomy Medial resection margin Prognostic factors Survival 

Supplementary material

11605_2012_1985_MOESM1_ESM.doc (31 kb)
Table S1 Logistic regression for covariates associated with R1 medial resection margin. PPPD pylorus-preserving pancreaticoduodenectomy. (DOC 31 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Yaojun Zhang
    • 1
  • Adam E. Frampton
    • 1
  • Patrizia Cohen
    • 2
  • Charis Kyriakides
    • 1
  • Jan J. Bong
    • 1
  • Nagy A. Habib
    • 1
  • Duncan R. C. Spalding
    • 1
  • Raida Ahmad
    • 2
  • Long R. Jiao
    • 1
    Email author
  1. 1.HPB Surgical Unit, Department of Surgery and CancerImperial CollegeLondonUK
  2. 2.Department of Histopathology, Imperial College Healthcare NHS TrustHammersmith HospitalLondonUK

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