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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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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.

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Authors and Affiliations

  1. West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK

    Nigel B. Jamieson, Euan J. Dickson, Colin J. McKay & C. Ross Carter

  2. Academic Unit of Surgery, University Department of Surgery, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow, UK

    Nigel B. Jamieson & Nigel I. J. Chan

  3. Department of Pathology, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK

    Alan K. Foulis

Authors
  1. Nigel B. Jamieson
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  2. Nigel I. J. Chan
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  3. Alan K. Foulis
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  4. Euan J. Dickson
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  5. Colin J. McKay
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Corresponding author

Correspondence to Nigel B. Jamieson.

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Jamieson, N.B., Chan, N.I.J., Foulis, A.K. et al. The Prognostic Influence of Resection Margin Clearance Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma. J Gastrointest Surg 17, 511–521 (2013). https://doi.org/10.1007/s11605-012-2131-z

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  • DOI: https://doi.org/10.1007/s11605-012-2131-z

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