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Original article
Relevance of Positive Resection Margins in Ductal Pancreatic Adenocarcinoma and Prognostic Factors
Relevancia del margen de resección positivo en adenocarcinoma ductal de páncreas y otros factores pronósticos
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Juan Ocañaa,
Corresponding author
jocajim@gmail.com

Corresponding author.
, Alfonso Sanjuanbenitoa, Alba Garcíaa, José Manuel Molinaa, Eduardo Lisaa, Elena Mendíaa, Cristina Saavedrab, Eduardo Loboa
a Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Received 27 March 2019. Accepted 27 June 2019
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Tables (4)
Table 1. Patient Characteristics According to Resection Margin.
Table 2. Univariate Analysis of the Resection Margins and Overall Survival.
Table 3. Surgical Complications Associated With Pancreaticoduodenectomy.
Table 4. Multivariate Analysis for Overall Survival.
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Abstract
Introduction

Currently, R1 resection is defined by the presence of tumor cells within <1 mm of the resection margin. The main aim of this study was to analyze the impact of positive margins (R1) on survival outcomes in pancreatic cancer.

Methods

We performed a retrospective analysis with multivariate regression analysis of a prospective database from 2008 to 2017, which included resection margin status, expanded resection margin (R1 < 1 mm), vascular resection, lymphatic involvement, surgical complications, tumor differentiation grade and adjuvant treatment.

Results

A total of 80 patients were analyzed: 42 (52%) R1; 38 (48%) R0. No differences were found in the composition of the two groups except for the vascular resection, which was more frequent in the R1 group: 12 (21%) vs 2 (3%). Overall survival in the R0 group was 19 months vs 24 months in the R1 group (P = .13). Wide R1 (R1 < 1 mm) had an overall survival of 21 months versus 31 months in wide R0 (P = .55). In the multivariate analysis, only lymph node involvement (P = .02, HR = 2.88), tumor differentiation (P = .02, HR = 3.2) and adjuvant therapy (P < .01; HR = 0.21) were found to be factors related to survival.

Conclusion

R1 resection is not an independent risk factor. Lymph node involvement, differentiation grade and adjuvant treatment are prognostic factors. The benefit of expanding the resection margins should be demonstrated. More studies are needed to assess the impact of the resection margin.

Keywords:
Pancreatic cancer
Resection margin
Overall survival
Prognostic factors
Resumen
Introducción

Actualmente en cirugía del cáncer de páncreas se considera margen de resección afecto (R1) la presencia de celular tumorales a <1 mm del borde de resección. El objetivo principal del estudio es analizar el impacto del margen de resección en la supervivencia.

Métodos

Análisis restrospectivo con análisis de regresión multivariante de una base de datos prospectiva 2008–2017, donde se incluye el margen de resección, el margen de resección ampliado (R1 < 1 mm), la resección vascular, la afectación linfática, las complicaciones quirúrgicas, la diferenciación tumoral y el tratamiento adyuvante.

Resultados

Un total de 80 pacientes fueron analizados 42 (52%) R1 y 38 (48%) R0. No se encontraron diferencias en la composición de ambos grupos salvo en la resección vascular, que fue mayor en el grupo R1, 12 (21%) vs 2 (3%). La supervivencia en el grupo R0 fue de 19 meses vs. 24 meses en el grupo R1 (p = 0,13). El margen ampliado (R1 < 1 mm) tuvo una supervivencia de 21 meses vs. 31 meses en R0 ampliado (p = 0,55). En el análisis multivariante solo se encontraron la afectación ganglionar (p = 0,02; HR = 2,88), la diferenciación tumoral (p = 0,02; HR = 3,2) y la adyuvancia (p < 0,01; HR = 0,21) como factores pronósticos de supervivencia.

Conclusiones

En el estudio la resección R1 no supone un factor pronóstico. La afectación ganglionar, el grado de diferenciación y el tratamiento adyuvante son factores pronósticos. Debe demostrarse el beneficio de ampliar los márgenes de resección. Son necesarios más estudios para valorar el impacto del margen de resección.

Palabras clave:
Cáncer de páncreas
Margen de resección
Supervivencia global
Factores pronósticos

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