title: Prognostic implications of the standardized study of resection margins in pancreatic cancers.
abstract: BACKGROUND
  Involvement of surgical resection margins is a fundamental prognostic factor in pancreatic oncological surgery. However, there is a lack of standardized histopathology definition. The aims of this study are to investigate the real rate of R1 resections when surgical specimens are evaluated according to a standardized protocol and to study its survival implications.
  One hundred consecutive surgically resected patients with pancreatic ductal adenocarcinoma were included in the study. They were further divided in 2 groups: pre-protocol, evaluated before the introduction of the standardized protocol and post-protocol, analyzed with the standardized protocol.
  
  
  RESULTS
  R0 resection rate in the pre-protocol group was 78%, falling to 47% after the introduction of the standardized protocol (p=0,003). The posterior retroperitoneal margin was the most frequently involved margin. In cases with tumors located at the pancreatic head and analyzed according to the standardized protocol R1 involvement negatively affected survival. Median survival in the R0 group was 22 months versus 16 in those with the margin involved (HR: 2.044; IC 95% 1,00-4,16; P=.043).
  
  
  CONCLUSIONS
  Standardized evaluation of the retroperitoneal margins in pancreatic cancer increases the rate of R1 patients. In cases with pancreatic cancer located at the pancreatic head involvement of posterior retroperitoneal margin significantly decreases survival.
authors.affiliation: Servicio de Cirugía General, Instituto de Investigación Sanitaria INCLIVA, Departamento de Cirugía, Universitat de València, Valencia, España. Electronic address: luis.sabater@uv.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Sabater
authors.affiliation: Servicio de Anatomía Patológica, Instituto de Investigación Sanitaria INCLIVA, Departamento de Patología, Universitat de València, Valencia, España.
authors.forename: María del Carmen
authors.initials: Mdel C
authors.lastname: Gómez-Mateo
authors.affiliation: Servicio de Cirugía General, Hospital San Pablo Coquimbo, Coquimbo, Chile.
authors.forename: Javier
authors.initials: J
authors.lastname: López-Sebastián
authors.affiliation: Servicio de Cirugía General, Instituto de Investigación Sanitaria INCLIVA, Departamento de Cirugía, Universitat de València, Valencia, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Muñoz-Forner
authors.affiliation: Servicio de Cirugía General, Instituto de Investigación Sanitaria INCLIVA, Departamento de Cirugía, Universitat de València, Valencia, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Morera-Ocón
authors.affiliation: Servicio de Hematología y Oncología Médica, Instituto de Investigación Sanitaria INCLIVA, Universitat de València, Valencia, España.
authors.forename: Andrés
authors.initials: A
authors.lastname: Cervantes
authors.affiliation: Servicio de Hematología y Oncología Médica, Instituto de Investigación Sanitaria INCLIVA, Universitat de València, Valencia, España.
authors.forename: Susana
authors.initials: S
authors.lastname: Roselló
authors.affiliation: Servicio de Hematología y Oncología Médica, Instituto de Investigación Sanitaria INCLIVA, Universitat de València, Valencia, España.
authors.forename: Bruno
authors.initials: B
authors.lastname: Camps-Vilata
authors.affiliation: Servicio de Anatomía Patológica, Instituto de Investigación Sanitaria INCLIVA, Departamento de Patología, Universitat de València, Valencia, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferrández
authors.affiliation: Servicio de Cirugía General, Instituto de Investigación Sanitaria INCLIVA, Departamento de Cirugía, Universitat de València, Valencia, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ortega
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies
keywords: Cáncer de páncreas; Duodenopancreatectomía; Oncological resection; Pancreatic cancer; Pancreatoduodenectomy; R1 resection; Resección R1; Resección oncológica