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Prognostic implications of resection margin status in distal pancreatectomy for pancreatic ductal adenocarcinoma

  • 0Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Hpb : the Official Journal of the International Hepato Pancreato Biliary Association +

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April 26, 2025

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April 26, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

For distal pancreatectomy, a tumor-free margin of 0 mm (R1) is a significant predictor of shorter survival. Achieving a microscopically negative posterior margin is crucial for improving patient outcomes in pancreatic cancer surgery.

Area Of Science

  • Surgical Oncology
  • Gastroenterology
  • Pathology

Background

  • Curative resection is a key prognostic factor in pancreatectomy.
  • The definition and clinical significance of resection margins in distal pancreatectomy are debated.

Purpose Of The Study

  • To evaluate the prognostic impact of different resection margin definitions (0 mm vs. 1 mm) in distal pancreatectomy for pancreatic cancer.
  • To identify specific margins that influence survival outcomes.

Main Methods

  • Analysis of 203 patients undergoing distal pancreatectomy for pancreatic cancer (2010-2018).
  • Classification into R0-wide (≥1 mm tumor-free margin), R0-narrow (0 < margin < 1 mm), and R1 (0 mm margin) groups.
  • Evaluation of individual margins: transection, anterior, and posterior.

Main Results

  • R1 margins were significantly associated with shorter overall survival (HR 2.02, p=0.001) compared to R0-wide margins.
  • Posterior margin involvement was identified as an independent poor prognostic factor (HR 1.83, p=0.027).
  • R0-narrow margins did not show a significant difference in overall survival compared to R0-wide margins (HR 1.17, p=0.446).

Conclusions

  • The 0 mm rule for resection margins appears more suitable for predicting prognosis in distal pancreatectomy than the 1 mm rule.
  • Achieving a microscopically negative posterior margin is critical for improving survival in patients undergoing distal pancreatectomy.