Resection Margin Clearance in Pancreatic Cancer After Implementation of the Leeds Pathology Protocol (LEEPP): Clinically Relevant or Just Academic?

• Published in: World journal of surgery Vol. 39; no. 2; pp. 493 - 499
• Main Authors: Gebauer, Florian, Tachezy, Michael, Vashist, Yogesh K., Marx, Andreas H., Yekebas, Emre, Izbicki, Jakob R., Bockhorn, Maximilian
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Cardiac Surgery; Circumferential Resection Margin; Female; General Surgery; Humans; Male; Median Overall Survival; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoplasm, Residual; Original Scientific Report; Overall Survival; Pancreatic cancer; Pancreatic Head; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Prospective Studies; Resection Margin; Surgery; Survival Rate; Thoracic Surgery; Vascular Surgery; Circumferential Resection Margin; Resection Margin; Overall Survival; Median Overall Survival; Pancreatic Head
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-014-2808-4

Background and objectives The aim of this study was to assess the overall survival (OS) after R0/R1 resections in patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head after implementation of a standardized histopathologic protocol (Leeds Pathology Protocol, LEEPP). Methods One hundred and twenty-five patients underwent surgical resection because of PDAC of the pancreatic head. Patients were histopathologically examined according to a standardized protocol. Their oncologic outcome and clinicopathologic data were compared with those of a patient group before implementation of the LEEPP ( n  = 116). Results The R1 rate increased significantly from 13 to 52 %. There was no significant difference in OS between R0 and R1 resections. The median OS in patients with a tumor clearance of less than 2 mm from the resection margin was 15.1 months (12.1–18.1 months) versus 22.2 months (7.8–36.7 months) ( P  = 0.046). Multivariate analysis revealed a margin clearance or 2 mm and more as an independent prognosticator for OS. Conclusions With applying the LEEPP, there was still no significant correlation between the R-status and OS in patients with PDAC. However, since a margin clearance of 2 mm or more is a predictive factor for OS, the R1 definition might have to be adapted in PDAC.