Microscopic Residual (R1) after Resection for Pancreatic Carcinoma Influences the Recurrence Type but not Prognosis: A Prospective Study on 88 Patients

Giardino A, Falconi M, Marcucci S, Muselli P, Barugola G, Valli L, Pederzoli P

Department of Surgery and Gastroenterology, University of Verona. Verona, Italy

Background and aim Given the absence of uniform data in literature, the aim is to establish the clinical impact of microscopic residual (R1) on the margins after pancreatic resection for ductal carcinoma, on the progression of the disease; this on the basis of an accurate pathological study.

Patients and methods In 1977 we standardized a new protocol for the analysis of the specimens after pancreatic resection. From 1977 to 2002, 101 patients underwent resection for ductal carcinoma: 13 patients were excluded from the study (1 postoperative death, 12 R2). The remaining 88 patients were divided into two groups, according to the status of margins (R0 vs. R1) and subsequently assessed, according to site of the tumour, time to recurrence, survival, and antitumoral therapies.

Results The margins were found microscopically positive in 28 patients (31.8%). R0 and R1 are homogeneous in clinical characteristics, type of operation, and recourse to adjuvant therapies. The presence of angioinvasion was found to be the most represented prognostic factor in R1 (R0 50% vs. R1 82%; P=0.005). The risk of local recurrence after 12 and 24 months is higher in R1 than in R0 (R1: 12 months 28%, 24 months 56%, vs. R0: 12 months 12.4%, 24 months: 19.3%; P=0.03), while the risk of liver metastasis and time of recurrence are equal. The median of survival in R0 and R1 is 42 months (95% CI: 14.8-69.1 months) and 21.5 months (95% CI: 20.6-22.4 months) (P=0.1), respectively. The multivariate analysis has shown nodal status to be the only independent prognostic factor both for recurrence, in any site, and survival.

Conclusions The presence of tumoral cells on the resection margins is associated with a significant risk of local recurrence. Nevertheless, the clinical impact is mitigated by the high number of hepatic recurrence and by the fact that the aggressiveness of the disease itself can be better interpreted considering the more classical pathological parameters of the specimen, like nodal status.

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