UICC-R Classification and Distance of the Tumour from Rescetion Margin Are Inadequate to Predict Local Recurrence After Pancreatic Cancer Resection
Capitanio V1, Balzano G1, Zerbi A1, Stratta G1, Reni M2, Cereda S2, Albarello L3, Di Carlo V1
Pancreas Unit, Departments of 1Surgery, 2Oncology and 3Pathology, S. Raffaele Scientific Institute. Milan, Italy
ABSTRACT
Context According to the UICC-R classification, if a tumor is 1 mm or less from the resection margin, it must be coded R0 (no residual tumor); only if a tumor is transected must be coded R1 (microscopic residual tumor). The high rate of margin invasion and nodal metastases could explain the frequent occurrence of local failure after surgery. No data are available on the recurrence rate of the few patients in which surgery achieved an apparent radicality, namely R0-N0 patients. Aim To assess the relationship between the distance of the tumor from surgical resection margin and risk of local recurrence and long term survival. Methods Between 1995 and 2005, 384 resections for ductal adenocarcinoma were performed. Pathologic evaluation of margins was made by multiple axial sections after specimen inking. Margin invasion was found in 168 patients (44%); 309 patients (80%) had positive lymphnodes. We retrospectively reviewed 34 R0-N0 patients. At pathologic re-evaluation, 2 of them resulted biliary duct carcinoma, 1 ampullary carcinoma and 3 were R1 pancreatic cancer. The remaining 28 cases were considered for the analysis (12 of them resulted invasive IPM carcinoma): we re-evaluate minimal distance of the tumor from resection margin at the pathologic specimen. Median follow-up was 68 months (range 24-135 months); two patients were lost at the follow-up; disease failure was assessed by CT scan every 3-4 months after surgery. Results Minimal distance of the tumor from resection margin was less than 4mm in 19 patients (group A; average distance: 1.3 mm) and equal to, or greater than, 4mm in 9 patients (group B; average distance: 6 mm). During the follow-up a recurrence was detected in 53.5% of patients: 8 patients (28.5%) had only distant metastases, 3 (11%) had only local relapse and 4 (14%) had both. Five patients of group A (26%) and 2 of group B (22%) presented a local relapse. Median recurrence of disease was 15 months and median local recurrence was 23 months. Median overall survival was 34 months; in group A median survival was 21 months, in group B it was 44.5 months. Seven patients are alive in absence of recurrence of disease: 6 of them are affected by invasive IPM carcinoma; 3 invasive IPM carcinomas locally relapsed. Conclusions The distance of the tumor from resection margin seems to be a prognostic factor but it is inadequate to predict local recurrence. Among R0N0 patients those affected by invasive IPM carcinoma are more likely to be cured.
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