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Prognostic significance of involvement of the circumferential resection margin/surface in patients with pancreatic head cancer: A prospective evaluation of pancreatoduodenectomy specimens using the 0 and 1 mm rules

  • 0Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Pancreatology : Official Journal of the International Association of Pancreatology (iap) ... [et Al.] +

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September 10, 2024

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September 10, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

The 0 mm rule for circumferential resection margin (CRM) involvement is a better predictor of survival in pancreatic cancer than the 1 mm rule. Circumferential surface (CS) involvement showed no significant prognostic value.

Area Of Science

  • Surgical Oncology
  • Gastroenterology
  • Pathology

Background

  • The prognostic value of circumferential resection margin (CRM) and circumferential surface (CS) in pancreatic head cancer remains debated.
  • Accurate assessment of surgical margins is crucial for predicting patient outcomes after pancreatoduodenectomy.

Purpose Of The Study

  • To investigate the prognostic significance of CRM and CS involvement in pancreatic ductal adenocarcinoma (PDAC) following pancreatoduodenectomy.
  • To compare survival outcomes based on different margin classification rules (0 mm and 1 mm).

Main Methods

  • Prospective collection of 102 pancreatoduodenectomy specimens from PDAC patients undergoing upfront surgery (2014-2018).
  • Classification of margins as CRM (superior mesenteric vein/portal vein or superior mesenteric artery) and CS (anterior or posterior surfaces).
  • Analysis of survival outcomes and recurrence based on CRM/CS status categorized by 0 mm and 1 mm rules (R1<sub>0mm</sub>, R1<sub>1mm</sub>, R0).

Main Results

  • R1<sub>0mm</sub> CRM was significantly associated with lower overall survival (OS) and disease-free survival (DFS) compared to R1<sub>1mm</sub> and R0 (P < 0.001).
  • No significant difference in survival was observed between R1<sub>1mm</sub> and R0 CRM, or between R1<sub>0mm</sub> and R1<sub>1mm</sub> CS.
  • R1<sub>0mm</sub> CRM was an independent risk factor for OS (HR 2.410, P=0.003) and DFS (HR 5.019, P < 0.001).
  • R1<sub>0mm</sub> superior mesenteric artery margin involvement was significantly linked to local recurrence (P=0.012).

Conclusions

  • The 0 mm rule for CRM involvement is more appropriate for predicting survival outcomes in PDAC than the 1 mm rule.
  • Circumferential surface (CS) involvement, regardless of the 0 or 1 mm rule, does not appear to have significant prognostic value.

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