title: Outcome of R1 resection in patients undergoing pancreatico-duodenectomy for pancreatic cancer.
abstract: BACKGROUND
  Pancreatico-duodenectomy (PD) is the only potentially curative treatment for pancreatic cancer, but most surgeons are reluctant to perform a palliative resection. The aim was to define the outcome for microscopically incomplete PD (R1).
  
  
  METHODS
  Ninety-nine consecutive patients underwent laparotomy to perform PD. Sixty-seven patients were resected and 32 underwent palliative bypass (PSB) because of locally advanced disease.
  
  
  RESULTS
  Of the 67 PD, 27 were classified as R0 and 40 as R1. Median survival for R0, R1 and PSB were 24, 18 and 9 months, respectively. Survival in the PSB group was 34% at 1 year and 0% at 2 years. 1-, 2- and 5-year survival in the R0 and R1 groups was 79% and 70%, 48.3% and 39.1%, 21.5% and 9.9%, respectively. Compared to PSB, both other groups were less likely to die over follow-up (p=0.002). Survival was not significantly different between the R0 and R1 groups (p=0.21). Perioperative morbidity and mortality were similar in the PD and PSB groups (29.9% and 3.0% vs 31.3 and 3.1%, respectively, p=1.00).
  
  
  CONCLUSIONS
  Better survival in the resection group and similar perioperative risk would support the decision to perform PD even when there is the possibility of incomplete microscopic clearance.
authors.affiliation: University Department of Surgery and Liver Transplant Unit, Royal Free Hospital, Royal Free and University College Medical School, Pond Street, NW3 2QG London, United Kingdom. g.fusai@medsch.ucl.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Fusai
authors.forename: N
authors.initials: N
authors.lastname: Warnaar
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
authors.forename: S
authors.initials: S
authors.lastname: Archibong
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology