Redefining the R1 resection in pancreatic cancer

Background: Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status. Methods: A standardized p...

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Bibliographic Details
Published in:British journal of surgery 2006-10, Vol.93 (10), p.1232-1237
Main Authors: Verbeke, C. S., Leitch, D., Menon, K. V., McMahon, M. J., Guillou, P. J., Anthoney, A.
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Biological and medical sciences
Chemotherapy, Adjuvant
Cohort Studies
Female
Follow-Up Studies
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Practice Guidelines as Topic - standards
Survival Analysis
Tumors
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Summary:Background: Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status. Methods: A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. R1 resection was defined as tumour within 1 mm of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non‐standardized protocol was used (NSP series, n = 48). Results: Implementation of the SP resulted in a higher R1 rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0·001), but not for the NSP series. There was a trend towards better median and actuarial 5‐year survival after R0 resection in the SP pancreatic cancer subgroup. Conclusion: Standardized examination influences the reporting of RM status. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. The pathologist is also a prognostic factor
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.5397