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KMID : 0371420221020010010
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Annals of Surgical Treatment and Research
2022 Volume.102 No. 1 p.10 ~ p.19
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Oncologic outcomes according to the location and status of resection margin in pancreas head cancer: role of radiation therapy in R1 resection
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Sohn Hee-Ju
Kim Hong-Beom
Kim Sun-Joo
Lee Kyung-Bun
Han Young-Min
Lee Jung-Min
Kang Jae-Seung
Kwon Woo-Il
Chie Eui-Kyu
Kim Hae-Ryoung
Jang Jin-Young
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Abstract
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Purpose: The clinical significance of margin status in pancreatic head cancer is still controversial due to the nonstandardized definition of R status and pathologic reporting. This study aims to evaluate the impact of the margin status including location and the role of radiation therapy in pancreatic head cancer.
Methods: A total of 314 patients who underwent curative-intent surgery for pancreatic head cancer between 2010 and 2017 were analyzed. Demographics, survival, and local recurrences were compared according to 2 definitions: 0-mm R1 as direct involvement and 1-mm R1 as close resection margin less than 1 mm. The specific margins were divided into 4 groups according to the location around the pancreas: pancreas transection, anterior surface, posterior surface, and vessel (superior mesenteric artery/superior mesenteric vein) margin.
Results: The 0-mm R1-rate was 15.6%, and increased to 36.3% in 1-mm R1. The median overall survival rate of 0-mm R0 vs. R1 was 26 months vs. 16 months (P = 0.052) and that of 1-mm R0 vs. R1 was 27 months vs. 18 months, respectively (P = 0.016). In individual margins, posterior, anterior surface, and pancreas transection margin involvement were associated with poor outcome, and the 1 mm posterior surface involvement was an independent risk factor for disease-free survival (hazard ratio, 1.63). Adjuvant radiation therapy had oncologic benefits, especially in R1 patients (P = 0.011) compared to R0 patients (P = 0.088).
Conclusion: Margin status, especially 1-mm R1 status is an important predictive factor, and involved posterior surface has a clinical impact. Patients with positive margins should be considered adjuvant radiation therapy.
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KEYWORD
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Disease-free survival, Margins of excision, Pancreatic neoplasms, Pancreaticoduodenectomy, Prognosis
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