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Redefining the R1 resection in pancreatic cancer.

C S Verbeke1, D Leitch, K V Menon

  • 1Department of Histopathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK. caroline.verbeke@leedsth.nhs.uk

The British Journal of Surgery
|June 29, 2006
PubMed
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Standardized pathological examination significantly improves the reporting of resection margin (RM) status in pancreatic cancer surgery. This leads to more accurate R1 resection identification and better survival correlation.

Area of Science:

  • Oncology
  • Surgical Pathology
  • Gastrointestinal Surgery

Background:

  • Histological assessment of resection margin (RM) status in pancreatic head adenocarcinoma lacks standardization.
  • Pathological examination protocols can influence the accuracy of RM status reporting.

Purpose of the Study:

  • To evaluate the impact of a standardized pathological examination protocol on reporting RM status in pancreaticoduodenectomy specimens.
  • To compare the outcomes of a standardized protocol series with a non-standardized protocol series.

Main Methods:

  • Development of a standardized protocol (SP) including multicolour margin staining, axial slicing, and extensive tissue sampling.
  • Definition of R1 resection as tumor within 1 mm of the RM.
  • Prospective comparison of an SP series (n=54) with a historical non-standardized protocol (NSP) series (n=48).

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Main Results:

  • The SP led to a higher R1 resection rate, particularly for pancreatic cancer (85%).
  • More extensive sampling of the circumferential RM in the SP series correlated with RM status.
  • RM involvement was often multifocal and survival correlated with RM status in the SP series (P < 0.001).

Conclusions:

  • Standardized pathological examination protocols demonstrably influence the reporting of RM status in pancreatic cancer.
  • The SP protocol enhances the accuracy of R1 resection identification and improves survival correlation.