Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

Table 1 Patient demographics

Clinicopathologic features	Value
Mean age (range), yr	59 (38-79)
Sex, M/F	76/48
Histopathologic diagnosis
Well differentiated	1
Moderately differentiated	74
Poorly differentiated	49
Adenocarcinoma	118
Adenocarcinoma + mucinouscarcinoma	5
Adenosquamous carcinoma	1
Stage (Union International Contre le Cancer, 8th ed)
I	59
II	57
III	7
IV	1
Resection margin status
R0	85
R1	38
R2	1
Median overall survival (range) in mo	16 (7-66)

Table 2 Factors associated with microscopically positive resection margin (R2 resection was excluded)

	No. patients		P value
	R0	R1
Total patients	85	38
Age in yr			0.192
≥ 60	47	22
< 60	39	15
Sex			0.719
M	53	23
F	33	14
Tumor size in cm			1.000
< 2	6	3
≥ 2	80	34
Bile duct invasion			0.486
Negative	28	15
Positive	58	23
Duodenal invasion			0.480
Negative	40	12
Positive	46	25
Nerve plexus invasion			0.848
Negative	36	13
Positive	50	24
Lymph node metastasis			0.562
Negative	54	21
Positive	32	16
Venous invasion			0.435
Negative	79	32
Positive	7	5
Postoperative chemotherapy			0.180
No	45	25
Yes	41	12
Postoperative radiotherapy			0.354
No	67	44
Yes	18	4
Operation blood loss in mL	251.61 ± 173.94	299.23 ± 216.67	0.195
Hospital stay in d	16.70 ± 7.98	16.31 ± 5.65	0.786

Table 3 Median survival of patients who underwent pancreaticoduodenectomy for pancreatic head adenocarcinoma (R2 resection was excluded)

Prognostic variables	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Age in yr
≥ 60	1.000	-	0.218
< 60	0.770	0.508-1.167
Sex
M	1.000	-	0.959
F	0.995	0.807-1.226
Tumor size in cm
≥ 2	1.000	-	0.140
< 2	0.507	0.206-1.251
Differentiation degree
Poor	1.000		0.791
Well + Middle	0.944	0.619-1.442
Margin status
R0	1.000	-	0.0101	1.000		0.0331
R1	1.773	1.149-2.736		1.632	1.041-2.529
Bile duct invasion
Negative	1.000	-	0.654
Positive	1.100	0.724-1.677
Duodenal invasion
Negative	1.000	-	0.415
Positive	1.188	0.785-1.796
Nerve plexus invasion
Negative	1.000	-	0.484
Positive	1.159	0.766-1.754
Lymph node metastasis
Negative	1.000	-	0.238
Positive	1.285	0.847-1.947
Venous invasion
Negative	1.000	-	0.0021	1.000		0.0101
Positive	2.771	1.447-5.304		2.395	1.237-4.636
Postop. chemotherapy			0.427
No	1.000	-
Yes	0.846	0.561-1.277
Postop. radiotherapy			0.944
No	1.000	-
Yes	1.018	0.624-1.660
Op. blood loss (100 mL)	1.001.	1.000-1.002	0.081
Postop. hospital stay	1.026	0.999-1.054	0.057

¹Statistically significant. HR: Hazard ratio; CI: Confidence interval.

Table 4 Summary of studies evaluating the impact of margin status on survival

Ref.	R1/R2 patients, n (%)	Resection status	Median R1/R2 survival in mo	Median R0 survival in mo
Podda et al[19], 2017	34 (36)	R1	18	26
Sugiura et al[20], 2013	40 (19)	R1	23	30
Petermann et al[13], 2013	36 (38)	R1	14	19
Zhang et al[14], 2012	48 (57)	R1	17	29
Rau et al[21], 2012	56 (44)	R1	14	19
Fatima et al[22], 2010	149 (24)	R1/R2	15/10	19
Kato et al[4], 2009	61 (35)	R1/R2	9/6	15
Raut et al[5], 2007	60 (17)	R1	22	28
Present study	38 (31)	R1	16	23