Prognosis of resected pancreatic cancer: is the refined resection margin status dispensable?

Excerpt

Pancreatic cancer is a tumor entity which is generally characterized by a poor prognosis. The only hope for cure lies in the radical resection of circumscribed tumors, or even better in the resection of precursor lesions, such as not-yet malignant intraductal papillary mucinous neoplasmns. Despite radical resection, patients with supposedly completely resected pancreatic carcinomas encounter local recurrences in many cases. The high recurrence rate does not correspond with the high R0 resection rates, which were reported to be about 70 % for pancreatoduodenectomies in most large surgical series. Some specialized pathologists for pancreatic diseases established a detailed 3-dimensional analysis of pancreatic resection specimen combined with a new R1 resection status, as defined as microscopic evidence of tumor within 1 mm from a resection margin [1, 2]. Just recently, our group confirmed the relevance of the refined R1 definition in a series of 1,071 consecutive patients with resected primary pancreatic adenocarcinomas [3]. Whereas R0 and R1 resections were associated with similar prognosis in the time period prior to the revised R1 definition, the revised R0 status was one of three independent positive predictors of patient survival (the others were Tis/T1/T2 status and G1 grading). …