There is extreme heterogeneity in the available literature on the determinationof R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is stilldebated. The aims of this multicenter randomized study were to evaluate the effect of samplingand clearance definition in determining R1 rate after PD for periampullary cancer and to assessthe prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds PathologyProtocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 ratewas determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence(LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimenswere included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively;with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively,while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resectionwas found to be a significant prognostic factor independent of clearance definition only in the case ofthe adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determiningthe R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognosticrole: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.

The role of pathological method and clearance definition for the evaluation of margin status after pancreatoduodenectomy for periampullary cancer. Results of a multicenter prospective randomized trial

Borzomati D;Petitti T;Perrone G;Coppola R;Caputo D
2021-01-01

Abstract

There is extreme heterogeneity in the available literature on the determinationof R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is stilldebated. The aims of this multicenter randomized study were to evaluate the effect of samplingand clearance definition in determining R1 rate after PD for periampullary cancer and to assessthe prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds PathologyProtocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 ratewas determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence(LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimenswere included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively;with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively,while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resectionwas found to be a significant prognostic factor independent of clearance definition only in the case ofthe adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determiningthe R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognosticrole: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.
2021
pancreatoduodenectomy,; margin status; R1 resection
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/11848
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