Redefining resection margin status in pancreatic cancer

Abstract

Curative resection is crucial to survival in pancreatic cancer; however, despite optimization and standardization of surgical procedures, this is not always achieved. This review highlights that the rates of microscopic margin involvement (R1) vary markedly between studies and, although resection margin status is believed to be a key prognostic factor, the rates of margin involvement and local tumour recurrence or overall survival of pancreatic cancer patients are often incongruent. Recent studies indicate that the discrepancy between margin status and clinical outcome is caused by frequent underreporting of microscopic margin involvement. Lack of standardization of pathological examination, confusing nomenclature and controversy regarding the definition of microscopic margin involvement have resulted in the wide variation of reported R1 rates that precludes meaningful comparison of data and clinicopathological correlation.

Keywords: cancer; pancreas; pathology; resection margin.

Figures

Figure 1

The circumferential resection margin in pancreatoduodenectomy (PD) specimens consists of the anterior surface, the medial surface facing the superior mesenteric vein (SMV), the surface flanking the superior mesenteric artery (SMA) and the posterior surface

Figure 2

Slicing of pancreatoduodenectomy (PD) specimens in an axial plane provides good views of the tumour and its relationship to the key anatomical structures and the entire circumferential resection margin