R0 Resection improves survival after multivisceral resection for pancreatic ductal adenocarcinoma

Achieving negative resection margins (R0) is central to curative surgery for pancreatic ductal adenocarcinoma (PDAC), but its prognostic relevance in multivisceral resections has been unclear. Using the largest international registry of multivisceral pancreatic resections, we performed a propensity score-matched analysis comparing R0 and R1 resections in patients undergoing multivisceral resection for PDAC. After 1:1 matching on pre- and intra-operative covariates, 222 patients were analyzed (111 R0, 111 R1). Perioperative morbidity, 90-day mortality, and intraoperative complications were comparable between groups. Median overall survival was 22.3 months after R0 resection versus 14.5 months after R1 resection; R1 status remained independently associated with poorer survival after adjustment for residual imbalances (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.02-2.07). Margin-negative resection is associated with improved long-term survival in multivisceral pancreatic surgery without an accompanying increase in perioperative risk, supporting R0 resection as a goal of surgical strategy at specialized centers.