Because patients who undergo surgical resection receive adjuvant treatment at a site other than the referral hospital, detailed information regarding the dose, frequency and completeness of this planned treatment was not available.I have read and accept the Wiley Online Library Terms and Conditions of Use Shareable Link Use the link below to share a full-text version of this article with your friends and colleagues.Learn more. Copy URL.
This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics andor technical factors associated with a positive resection margin in patients with PDAC. The effect of resection margin status, patient characteristics and tumour characteristics on LRR, distant metastasis and OS was assessed. A positive resection (R1) margin was found in 129 patients (401 per cent); this was associated with decreased OS compared with that in patients with an R0 margin (median 15 (95 per cent c.i. P versus 36 (not estimated, n.e.) months; P 0002). Risk factors for early recurrence were tumour stage, positive lymph nodes (N1) and perineural invasion. Among 100 patients with N0 disease, R1 status was associated with shorter OS compared with R0 resection (median 17 (10 to 24) versus 45 (n.e.) months; P 0002), whereas R status was not related to OS in 222 patients with N1 disease (median 14 (12 to 16) versus 17 (15 to 19) months after R1 and R0 resection respectively; P 0068). This may be related to incomplete resection of the tumour and a consequence of high recurrence rates 2 - 4. Other factors affecting outcome include tumour size 5, perineural andor lymphangioinvasion 6 and lymph node status 6 - 8. Resection margin (R) status remains the most controversial 4. Andersson R1 Free Resection MarginsOver two decades ago, Yeo and colleagues 9 reported that patients who underwent radical pancreatoduodenectomy with tumourfree resection margins (R0) had a 5year survival rate of 26 per cent, compared with only 8 per cent in those with positive margins (R1) 9. Ghaneh and coworkers 10 reported a difference in median survival between R0 and R1 resection (249 versus 187 months respectively) in a large multicentre RCT. An explanation could be the lack of standardized pathological evaluation of the specimen, or definition and reporting of resection margin status 15, 16. For example, in the USA, a resection margin is considered positive when tumour cells have reached the inked margin 9, 17. In Europe, a positive resection margin is defined by the presence of tumour cells within 1 mm of the resection margin 15, 18, 19. This discrepancy has led to a wide range of reported rates of resection margin involvement from less than 20 per cent to more than 75 per cent 18, 20 - 24. Recently, Osipov and colleagues 25 reported favourable diseasefree survival and OS after R0 resection, defined by the presence of tumour cells within 05 mm up to 2 mm from the resection margin. These results support the findings of Chang et al. Gebauer and coworkers 27, who also recommended a resection margin of 15 or 2 mm. This is based on the finding that isolated locoregional recurrence (LRR) without distant metastases is found in only 1025 per cent of patients 11, 30. Patients with a histological diagnosis of PDAC who were scheduled for curative pancreatic resection between January 2006 and December 2016 were identified from an electronic institutional database. Patients with any other histopathological diagnosis were excluded, including those with malignant intraductal papillary mucinous neoplasms. Operative data and patient characteristics were collected in the database, including age at time of surgery, sex and type of surgery. Tumour characteristics recorded were: pTNM stage, grade, histopathological diagnosis, lymph node involvement, total number of resected lymph nodes, lymph node ratio, and lymphangioinvasion andor perineural invasion. The criteria for a nonresectable tumour were: presence of distant metastases; obvious involvement of coeliac andor paraaortic nodes; and contact with the superior mesenteric artery, common hepatic artery, coeliac trunk of more than 90, or encasement of the superior mesenteric or portal vein. All tumours were classified before surgery as resectable or borderline resectable according to Dutch Pancreatic Cancer Group (DPCG) 2012 criteria (PREOPANC trial) 31. In the Netherlands, the standard for adjuvant chemotherapy is six cycles of gemcitabine.
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