Pancreatoduodenectomy for ductal adenocarcinoma: Implications of positive margin on survival

Objective: To assess the effect of R0 resection margin status and R0 en bloc resection in pancreatoduodenectomy outcomes. Design: Retrospective medical record review. Setting: Mayo Clinic, Rochester, Minnesota. Patients: Patients who underwent pancreatoduodenectomy for pancreatic adenocarcinoma at our institution between January 1, 1981, and December 31, 2007, were identified and their medical records were reviewed. Main Outcome Measure: Median survival times. Results: A total of 617 patients underwent pancreatoduodenectomy. Median survival times after R0 en bloc resection (n=411), R0 non-en bloc resection (n=57), R1 resection (n=127), and R2 resection (n=22) were 19, 18, 15, and 10 months, respectively (P<.001). A positive resection margin was associated with death (P=.01). No difference in survival time was found between patients undergoing R0 en bloc and R0 resections after reexcision of an initial positive margin (hazard ratio, 1.19; 95% confidence interval, 0.87-1.64; P=.28). Conclusions: R0 resection remains an important prognostic factor. Achieving R0 status by initial en bloc resection or reexcision results in similar long-term survival.