Journal of Gastrointestinal Surgery

, Volume 17, Issue 3, pp 511–521 | Cite as

The Prognostic Influence of Resection Margin Clearance Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

  • Nigel B. Jamieson
  • Nigel I. J. Chan
  • Alan K. Foulis
  • Euan J. Dickson
  • Colin J. McKay
  • C. Ross Carter
Original Article

Abstract

Introduction

The poor overall survival associated with pancreatic ductal adenocarcinoma (PDAC) despite complete resection suggests that occult metastatic disease is present in most at the time of surgery. Resection margin involvement (R1) following resection is an established poor prognostic factor. However, the definition of an R1 resection varies and the impact of margin clearance on outcome has not been examined in detail.

Methods

In a cohort of 217 consecutive patients who underwent pancreaticoduodenectomy for PDAC with curative intent at a single institution between 1996 and 2011, the prognostic significance of the proximity of margin clearance was investigated. Microscopic margin clearance was stratified by 0.5 mm increments from tumor present at the margin to >2.0 mm. Groups were dichotomized into clear and involved groups according to the different R1 definitions. Multivariate survival analysis was used to establish independent prognostic factors.

Results

For the 38 patients (17.5 %) where the tumor was >1.5 mm from the closest involved margin, there was a significantly prolonged overall median survival (63.1 months; 95 % confidence interval, 32.5–93.8) compared to R1 resections (16.9 months; 95 % confidence interval, 14.5–19.4; P < 0.0001, log-rank test). This cutoff represented the optimum distance for predicting long-term survival. As margin clearance increased, R1 status became a more powerful independent predictor of outcome; however, margin clearance did not relate to site of tumor recurrence.

Conclusion

These data demonstrate that margin clearance by at least 1.5 mm identifies a subgroup of patients which may potentially achieve long-term survival. This study further confirms the need to achieve standardization across pancreatic specimen reporting. Stratification of patients into future clinical trials based upon the degree of margin clearance may identify those patients likely to benefit from adjuvant therapy.

Keywords

Pancreatic cancer Resection margin clearance Pancreaticoduodenectomy Prognosis Recurrence 

Notes

Acknowledgments

The authors would like to thank Dr. Ian Stewart and Dr. Cindy Chew for the diagnostic imaging, the West of Scotland Pancreatic Unit nurse specialists Elspeth Cowan and Linda Dewar for the follow-up data, as well as the West of Scotland Pancreatic Unit audit secretary Diane Stewart.

Supplementary material

11605_2012_2131_MOESM1_ESM.docx (95 kb)
ESM 1 (DOCX 94 kb)
11605_2012_2131_MOESM2_ESM.docx (56 kb)
ESM 2 (DOCX 56 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Nigel B. Jamieson
    • 1
    • 2
  • Nigel I. J. Chan
    • 2
  • Alan K. Foulis
    • 3
  • Euan J. Dickson
    • 1
  • Colin J. McKay
    • 1
  • C. Ross Carter
    • 1
  1. 1.West of Scotland Pancreatic UnitGlasgow Royal InfirmaryGlasgowUK
  2. 2.Academic Unit of Surgery, University Department of Surgery, College of Medical, Veterinary and Life of SciencesUniversity of GlasgowGlasgowUK
  3. 3.Department of PathologyGlasgow Royal InfirmaryGlasgowUK

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