Impact of margin status on survival following pancreatoduodenectomy for cancer: the Leeds Pathology Protocol (LEEPP)

Abstract

Background: In a previous study we reported an 85% R1 rate for pancreatic cancer following the use of the rigorous, fully standardized Leeds Pathology Protocol (LEEPP). As this significantly exceeded R1 rates observed by others, we investigated the reproducibility of margin assessment using the LEEPP in a larger, prospective, observational cohort study and correlated clinicopathological data with survival.

Methods: Clinicopathological features, including exact site and multifocality of margin involvement, and survival were collated from a prospective series of 83 pancreatoduodenectomies for pancreatic (n = 27), ampullary (n = 24) and bile duct cancer (n = 32). Data were compared with those of the previous study in which the same pathology protocol, based on axial slicing and extensive tissue sampling from the circumferential margin, had been used.

Results: The R1 rate was high in pancreatic (82%) and bile duct (72%) cancer and significantly lower in ampullary cancer (25%). Margin positivity was often multifocal, the posterior margin being most frequently involved. Margin status correlated with survival in the entire cohort (P = 0.006) and the pancreatic subgroup (P = 0.046). These findings were consistent with observations in our previous study.

Conclusions: Margin involvement in pancreatic cancer is a frequent and prognostically significant finding when specimens are assessed using the LEEPP.

Keywords: cancer; margin; pancreas; resection; survival.

Figures

Figure 1

Specimen dissection according to the Leeds Pathology Protocol. Following multicolour-coded inking of the specimen surface, pancreatoduodenectomy specimens are sliced in an axial plane, providing a large number of specimen slices with good visualization of the tumour and its relationship to key anatomical structures and the anterior, posterior and superior mesenteric vein groove surfaces

Figure 2

Survival of patients with pancreatic cancer. The actual survival curve for the 27 patients with pancreatic cancer shows that patients who underwent an R0 resection had a significantly better outcome than those in whom an R1 resection was performed (P = 0.046)