The impact of margin status determined by the one-millimeter rule on tumor recurrence and survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
OBJECTIVE
The tumor-node-metastasis (TNM) classification defines R1 as the presence of tumor cells at the resection margin, while the current Royal College of Pathologists guidelines for pancreaticoduodenectomy specimens regard the presence of tumor cells within 1 mm from the resection margin as R1 (the "1-mm rule"). The aims of this study were to investigate the resection margin status of pancreatic head cancer retrospectively according to both the TNM and 1-mm rule classifications, and to evaluate the postoperative survival and tumor recurrence patterns.


METHODS
A total of 117 patients with pancreatic head cancer were the subjects of this study.


RESULTS
R11-mm ruleresection was associated with a significantly worse disease-free survival (DFS) than R01-mm ruleresection (p = 0.0259), while R1TNMhad no impact on DFS. R11-mm ruleresection margin status correlated with the incidence of tumor recurrence in the liver (p = 0.0483). In a multivariate analysis, R11-mm ruleresection was the independent variable for predicting poor DFS (hazard ratio 1.71; p = 0.0289).


CONCLUSIONS
R1 resection margin status determined by the 1-mm rule may be an independent indicator for predicting disease recurrence, especially liver metastasis. These results may be useful for selecting the appropriate adjuvant therapy protocol and conducting strict surveillance in PDAC patients.
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Takeo
T
Nitta
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan. torunakamura@med.hokudai.ac.jp.
Toru
T
Nakamura
Department of Surgical Pathology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Tomoko
T
Mitsuhashi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Toshimichi
T
Asano
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Keisuke
K
Okamura
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Takahiro
T
Tsuchikawa
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Eiji
E
Tamoto
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Soichi
S
Murakami
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Takehiro
T
Noji
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Yo
Y
Kurashima
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Yuma
Y
Ebihara
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Yoshitsugu
Y
Nakanishi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Toshiaki
T
Shichinohe
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Satoshi
S
Hirano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies
1-mm rule; Disease-free survival; Margin; Pancreatic ductal adenocarcinoma; TNM
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