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Updated: Jun 16, 2026
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival
Javairiah Fatima1, Thomas Schnelldorfer, Joshua Barton
1Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Objective:
To assess the effect of R0 resection margin status and R0 en bloc resection in pancreatoduodenectomy outcomes.
Design:
Retrospective medical record review.
Setting:
Mayo Clinic, Rochester, Minnesota.
Patients:
Patients who underwent pancreatoduodenectomy for pancreatic adenocarcinoma at our institution between January 1, 1981, and December 31, 2007, were identified and their medical records were reviewed.
Main Outcome Measure:
Median survival times.
Results:
A total of 617 patients underwent pancreatoduodenectomy. Median survival times after R0 en bloc resection (n = 411), R0 non-en bloc resection (n = 57), R1 resection (n = 127), and R2 resection (n = 22) were 19, 18, 15, and 10 months, respectively (P < .001). A positive resection margin was associated with death (P = .01). No difference in survival time was found between patients undergoing R0 en bloc and R0 resections after reexcision of an initial positive margin (hazard ratio, 1.19; 95% confidence interval, 0.87-1.64; P = .28).
Conclusions:
R0 resection remains an important prognostic factor. Achieving R0 status by initial en bloc resection or reexcision results in similar long-term survival.
