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The impact of margin status determined by the one-millimeter rule on tumor recurrence and survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

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Abstract

Purpose

The tumor-node-metastasis (TNM) classification defines R1 as the presence of tumor cells at the resection margin, while the current Royal College of Pathologists guidelines for pancreaticoduodenectomy specimens regard the presence of tumor cells within 1 mm from the resection margin as R1 (the “1-mm rule”). The aims of this study were to investigate the resection margin status of pancreatic head cancer retrospectively according to both the TNM and 1-mm rule classifications, and to evaluate the postoperative survival and tumor recurrence patterns.

Methods

A total of 117 patients with pancreatic head cancer were the subjects of this study.

Results

R11-mm rule resection was associated with a significantly worse disease-free survival (DFS) than R01-mm rule resection (p = 0.0259), while R1TNM had no impact on DFS. R11-mm rule resection margin status correlated with the incidence of tumor recurrence in the liver (p = 0.0483). In a multivariate analysis, R11-mm rule resection was the independent variable for predicting poor DFS (hazard ratio 1.71; p = 0.0289).

Conclusions

R1 resection margin status determined by the 1-mm rule may be an independent indicator for predicting disease recurrence, especially liver metastasis. These results may be useful for selecting the appropriate adjuvant therapy protocol and conducting strict surveillance in PDAC patients.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan

    Takeo Nitta, Toru Nakamura, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Eiji Tamoto, Soichi Murakami, Takehiro Noji, Yo Kurashima, Yuma Ebihara, Yoshitsugu Nakanishi, Toshiaki Shichinohe & Satoshi Hirano

  2. Department of Surgical Pathology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan

    Tomoko Mitsuhashi

Authors
  1. Takeo Nitta
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  2. Toru Nakamura
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  3. Tomoko Mitsuhashi
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Corresponding author

Correspondence to Toru Nakamura.

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The authors declare no conflicts of interest in association with this study.

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Nitta, T., Nakamura, T., Mitsuhashi, T. et al. The impact of margin status determined by the one-millimeter rule on tumor recurrence and survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Surg Today 47, 490–497 (2017). https://doi.org/10.1007/s00595-016-1420-7

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  • DOI: https://doi.org/10.1007/s00595-016-1420-7

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