title: Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated.
  
  
  METHODS
  Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed.
  
  
  RESULTS
  For PDAC, the R1 rate was 57.1% (48/84) for any margin, 31.0% (26/84) for anterior surface, 42.9% (36/84) for posterior surface, 29.8% (25/84) for medial margin, and 7.1% (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17.2 vs. 28.7 months, P = 0.007 and 12.3 vs. 21.0 months, P = 0.019, respectively). For individual margins, only medial positivity had a significant impact on survival (13.8 vs. 28.0 months, P < 0.001), as opposed to involvement in the anterior (19.7 vs. 23.3 months, P = 0.187) or posterior margin (17.5 vs. 24.2 months, P = 0.104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0.002, HR = 0.381; 95% CI 0.207-0.701).
  
  
  CONCLUSIONS
  The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.
authors.affiliation: HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, UK.
authors.forename: Yaojun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Adam E
authors.initials: AE
authors.lastname: Frampton
authors.forename: Patrizia
authors.initials: P
authors.lastname: Cohen
authors.forename: Charis
authors.initials: C
authors.lastname: Kyriakides
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Bong
authors.forename: Nagy A
authors.initials: NA
authors.lastname: Habib
authors.forename: Duncan R C
authors.initials: DR
authors.lastname: Spalding
authors.forename: Raida
authors.initials: R
authors.lastname: Ahmad
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
mesh_terms: D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome