The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma

Abstract

R1-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.

Impact of resection margin status on recurrence and survival in pancreatic cancer surgery

“…Their data are consistent with the present finding that the vascular margin was associated with clinical outcomes, albeit not significantly. In a recent study of 1151 patients, a positive direct posterior resection margin was associated with reduced OS and recurrence‐free survival, whereas a positive direct superior mesenteric margin was associated with a higher local recurrence rate. For both margins, however, a R1 margin smaller than 1 mm did not affect clinically relevant outcomes.…”

“…Over two decades ago, Yeo and colleagues reported that patients who underwent radical pancreatoduodenectomy with tumour‐free resection margins (R0) had a 5‐year survival rate of 26 per cent, compared with only 8 per cent in those with positive margins (R1). Ghaneh and co‐workers reported a difference in median survival between R0 and R1 resection (24·9 versus 18·7 months respectively) in a large multicentre RCT.…”

Adjuvant chemotherapy and outcomes in patients with nodal and resection margin‐negative pancreatic ductal adenocarcinoma: A systematic review and meta‐analysis

“…In other studies not included within this meta‐analysis (they did not fulfill eligibility criteria), the presence of lymph node metastases has been identified as a factor associated with poor outcome after adjuvant chemotherapy in patients with resected PDAC, independent of resection margin status . A recent sub‐study evaluating the impact of positive resection margins on OS and recurrence in the 1,151 patients enrolled in the ESPAC 3 trial, reported that R1 resection margins were associated with reduced recurrence‐free survival and OS, and also that resection margin involvement was associated with increased risk of local recurrence . Another study which investigated the impact of chemoradiotherapy in a multicenter study of 152 patients who underwent an R0 resection for PDAC reported a benefit of chemoradiotherapy only in patients with node positive disease (HR, 0.68; 95% CI, 0.33‐0.88; P = 0.014) .…”

“…24,25 A recent sub-study evaluating the impact of positive resection margins on OS and recurrence in the 1,151 patients enrolled in the ESPAC 3 trial, reported that R1 resection margins were associated with reduced recurrence-free survival and OS, and also that resection margin involvement was associated with increased risk of local recurrence. 26 Another study which investigated the impact of chemoradiotherapy in a multicenter study of 152 patients who underwent an R0 resection for PDAC reported a benefit of chemoradiotherapy only in patients with node positive disease (HR, 0.68; 95% CI, 0.33-0.88; P = 0.014). 27 A large study of 747 patients randomized to chemoradiotherapy following surgery, or surgery alone, reported that only patients with lymph node-positive disease appeared to benefit from chemoradiotherapy, regardless of resection margin status, and appeared to negatively impact survival in the lymph node negative population.…”

Current Therapeutic Options for Pancreatic Ductal Adenocarcinoma

“…Outcome and complication rates appear to be at least partly attributable to treatment within or outside of high volume centers, while the largest share of variation appears to be due to patient-inherent factors [7,8,9]. There is currently no evidence to suggest a clinical benefit for neoadjuvant therapy in cases considered to be upfront surgically resectable [10,11].…”