Surgery Today

, Volume 47, Issue 4, pp 490–497 | Cite as

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

  • Takeo Nitta
  • Toru Nakamura
  • Tomoko Mitsuhashi
  • Toshimichi Asano
  • Keisuke Okamura
  • Takahiro Tsuchikawa
  • Eiji Tamoto
  • Soichi Murakami
  • Takehiro Noji
  • Yo Kurashima
  • Yuma Ebihara
  • Yoshitsugu Nakanishi
  • Toshiaki Shichinohe
  • Satoshi Hirano
Original Article

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.

Keywords

Pancreatic ductal adenocarcinoma Margin 1-mm rule TNM Disease-free survival 

Notes

Compliance with ethical standards

Conflict of interest

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

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Copyright information

© Springer Japan 2016

Authors and Affiliations

  • Takeo Nitta
    • 1
  • Toru Nakamura
    • 1
  • Tomoko Mitsuhashi
    • 2
  • Toshimichi Asano
    • 1
  • Keisuke Okamura
    • 1
  • Takahiro Tsuchikawa
    • 1
  • Eiji Tamoto
    • 1
  • Soichi Murakami
    • 1
  • Takehiro Noji
    • 1
  • Yo Kurashima
    • 1
  • Yuma Ebihara
    • 1
  • Yoshitsugu Nakanishi
    • 1
  • Toshiaki Shichinohe
    • 1
  • Satoshi Hirano
    • 1
  1. 1.Department of Gastroenterological Surgery IIHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Surgical PathologyHokkaido University HospitalSapporoJapan

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