Meta-analysis of radical resection rates and margin assessment in pancreatic cancer.
BACKGROUND
R0 resection rates (complete tumour removal with negative resection margins) in pancreatic cancer are 70-80 per cent when a 0-mm margin is used, declining to 15-24 per cent with a 1-mm margin. This review evaluated the R0 resection rates according to different margin definitions and techniques.


METHODS
Three databases (MEDLINE from 1946, PubMed from 1946 and Embase from 1949) were searched to mid-October 2014. The search terms included 'pancreatectomy OR pancreaticoduodenectomy' and 'margin'. A meta-analysis was performed with studies in three groups: group 1, axial slicing technique (minimum 1-mm margin); group 2, other slicing techniques (minimum 1-mm margin); and group 3, studies with minimum 0-mm margin.


RESULTS
The R0 rates were 29 (95 per cent c.i. 26 to 32) per cent in group 1 (8 studies; 882 patients) and 49 (47 to 52) per cent in group 2 (6 studies; 1568 patients). The combined R0 rate (groups 1 and 2) was 41 (40 to 43) per cent. The R0 rate in group 3 (7 studies; 1926 patients) with a 0-mm margin was 72 (70 to 74) per cent The survival hazard ratios (R1 resection/R0 resection) revealed a reduction in the risk of death of at least 22 per cent in group 1, 12 per cent in group 2 and 23 per cent in group 3 with an R0 compared with an R1 resection. Local recurrence occurred more frequently with an R1 resection in most studies.


CONCLUSIONS
Margin clearance definitions affect R0 resection rates in pancreatic cancer surgery. This review collates individual studies providing an estimate of achievable R0 rates, creating a benchmark for future trials.
National Health and Medical Research Clinical Trials Centre, University of Sydney, New South Wales, Australia.|Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.|Department of Surgery, Prince Charles Hospital, Queensland, Australia.
M D
MD
Chandrasegaram
Department of Medical Oncology, Prince of Wales Hospital, Prince of Wales Clinical School University of New South Wales, New South Wales, Australia.
D
D
Goldstein
National Health and Medical Research Clinical Trials Centre, University of Sydney, New South Wales, Australia.
J
J
Simes
National Health and Medical Research Clinical Trials Centre, University of Sydney, New South Wales, Australia.
V
V
Gebski
Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
J G
JG
Kench
Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia.
A J
AJ
Gill
Department of Surgery, Royal North Shore Hospital, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
J S
JS
Samra
Discipline of Surgery, School of Medicine, University of Western Sydney, New South Wales, Australia.|Department of Surgery, Prince Charles Hospital, Queensland, Australia.
N D
ND
Merrett
Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
A J
AJ
Richardson
University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
A P
AP
Barbour
D014943:Global Health; D006801:Humans; D015994:Incidence; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011379:Prognosis