The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Redefining the R1 resection in pancreatic cancer. BJS 2006; 93: 1232-1237.

Published: 27th June 2006

Authors: C. S. Verbeke, D. Leitch, K. V. Menon, M. J. McMahon, P. J. Guillou, A. Anthoney et al.

Background

Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status.

Method

A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. R1 resection was defined as tumour within 1 mm of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non‐standardized protocol was used (NSP series, n = 48).

Results

Implementation of the SP resulted in a higher R1 rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0·001), but not for the NSP series. There was a trend towards better median and actuarial 5‐year survival after R0 resection in the SP pancreatic cancer subgroup.

Conclusion

Standardized examination influences the reporting of RM status. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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