Table 2.
The effect of positive resection margins on survival in pancreatic cancer
| Study | Type of study | Patients included | Type of surgery | R‐definition | R0/R1 rate, absolute (%) | Years | Median survival | 5‐year survival rate | Adjuvant (chemo‐)therapy |
|---|---|---|---|---|---|---|---|---|---|
|
Uesaka 20164
JASPAC 01 |
RCT | 385 |
257 (68%): PD 116 (13%): DP 4 (19%): TP |
0‐mm rule |
R0 > 0 mm: 49 (13%) R1 0 mm: 328 (87%) |
2007‐2010 | Yes: 98.7% | ||
| 190 GEM |
136 (72%): PD 50 (26%): DP 4 (2%): TP |
R0 > 0 mm: 26 (14%) R1 0 mm: 164 (86%) |
25.5 months | 24.4% | |||||
| 187 S‐1 |
121 (65%): PD 66 (35%): DP 0 (0%): TP |
R0 > 0 mm: 23 (12%) R1 0 mm: 164 (88%) |
46.5 months | 44.1% | |||||
| Demir 201743 | Retrospective single‐center | 254 |
174 (67.5%): PD 44 (17.3): DP 36 (14.2%): TP |
0‐mm rule |
R0 > 0 mm: 153 (60.2%) R1 0 mm: 101 (39.8%) |
2007‐2014 |
R0 > 0 mm: 28.6 months R1 0 mm: 16.5 months |
All patients: 22.5% | Yes: 92% |
|
PD: R0 > 0 mm: 31.8 months R1 0 mm: 14.5 months | |||||||||
| 1‐mm rule |
R0 > 1 mm: 109 (42.9%) R1 0‐1 mm: 145 (57.1%) |
R0 > 1 mm: 31.7 months R1 0‐1 mm: 17.1 months |
|||||||
|
PD: R0 > 1 mm: 41.2 months R1 0‐1 mm: 16.8 months | |||||||||
| Nitta 201744 | Retrospective single‐center | 117 |
107 (91%): cPD 10 (9%): ppPD |
0‐mm rule |
R0 > 0 mm: 95 (81%) R1 0 mm: 22 (19%) |
1999‐2010 |
R0 > 0 mm: 17 months R1 0 mm: 12 months |
NA |
Yes: 46 (39%) No: 71 (61%) |
| 1‐mm rule |
R0 > 1 mm: 30 (26%) R1 0‐1 mm: 87 (74%) |
R0 > 1 mm: 20 months R1 0‐1 mm: 14 months |
|||||||
|
Neoptolemos 20173
ESPAC4 |
RCT | 730 |
251 (34%): ppPD 370 (51%): cPD 60 (8%): DP 49 (7%): TP |
1‐mm rule |
R0 ≥ 1 mm: 290 (40%) R1 0‐1 mm: 440 (60%) |
2008 ‐ 2011 | |||
| 366 GEM |
R0 ≥ 1 mm: 27.9 months R1 0‐1 mm: 23 months |
16.3% | Yes: 100% | ||||||
| 364 GEM/CAP |
R0 ≥ 1 mm: 39.5 months R1 0‐1 mm: 23.7 months |
28.8% | Yes: 98% | ||||||
| Ocuin 201745 | Retrospective single‐center | 310 | 310 (100%): PD | 1‐mm rule |
R0 > 1 mm: 130 (41.9%) R1 0‐1 mm: 113 (36.5%) R1 0 mm: 67 (21.6%) |
2002‐2014 |
R0 > 1 mm: 36.9 months R1 0‐1 mm: 22.6 months R1 0 mm: 15.4 months |
17.7% 9.7% 4.47% |
Yes: 181 (58%) No: 67 (20%) Radiochemotherapy: Yes: 62 (20%) |
| Strobel 201741 | Retrospective single‐center | 561 |
561 PD 72 (12.8%): cPD 427 (76.1%): ppPD 62 (11.1%): prPD |
1‐mm rule |
R0 > 1 mm: 112 (20%) R1 0‐1 mm: 123 (21.9%) R1 0 mm: 326 (58.1%) |
2006‐2012 |
R0 > 1 mm: 41.6 months R1 0‐1 mm: 27.5 months R1 0 mm: 23.4 months |
37.7% 30.1% 20.3% |
Yes: 438 (78.1%) No: 72 (12.8%) NA: 51 (9.1%) |
| Hank 201842 | Retrospective single‐center | 455 |
218 DP: (47.9%) 237 TP: (52.1%) |
1‐mm rule |
R0 > 1 mm: 107 (23.5%) R1 0‐1 mm: 104 (22.9%) R1 0 mm: 244 (53.6%) |
2006‐2014 |
R0 > 1 mm: 62.4 months R1 0‐1 mm: 24.6 months R1 0 mm: 17.2 months |
52.6% 16.8% 13% |
Yes: 81.5% No: 18.5% |
Studies were included on open abdominal pancreatic cancer surgery, beginning from 1996 with focus on survival and resection margin data.
Abbreviations: CAP, capecitabine; cPD, classic pancreatoduodenectomy; DP, distal pancreatectomy; GEM, gemcitabine; PD, pancreatoduodenectomy; PDAC, pancreatic ductal adenocarcinoma; ppPD, pylorus‐preserving pancreatoduodenectomy; prPD, pylorus‐resecting pancreatoduodenectomy; TP, total pancreatectomy.