title: Resection margin clearance in pancreatic cancer after implementation of the Leeds Pathology Protocol (LEEPP): clinically relevant or just academic?
abstract: OBJECTIVE
  The aim of this study was to assess the overall survival (OS) after R0/R1 resections in patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head after implementation of a standardized histopathologic protocol (Leeds Pathology Protocol, LEEPP).
  
  
  METHODS
  One hundred and twenty-five patients underwent surgical resection because of PDAC of the pancreatic head. Patients were histopathologically examined according to a standardized protocol. Their oncologic outcome and clinicopathologic data were compared with those of a patient group before implementation of the LEEPP (n = 116).
  
  
  RESULTS
  The R1 rate increased significantly from 13 to 52 %. There was no significant difference in OS between R0 and R1 resections. The median OS in patients with a tumor clearance of less than 2 mm from the resection margin was 15.1 months (12.1-18.1 months) versus 22.2 months (7.8-36.7 months) (P = 0.046). Multivariate analysis revealed a margin clearance or 2 mm and more as an independent prognosticator for OS.
  
  
  CONCLUSIONS
  With applying the LEEPP, there was still no significant correlation between the R-status and OS in patients with PDAC. However, since a margin clearance of 2 mm or more is a predictive factor for OS, the R1 definition might have to be adapted in PDAC.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246, Hamburg, Germany, fgebauer@uke.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Gebauer
authors.forename: Michael
authors.initials: M
authors.lastname: Tachezy
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Marx
authors.forename: Emre
authors.initials: E
authors.lastname: Yekebas
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate