Resection margin clearance in pancreatic cancer after implementation of the Leeds Pathology Protocol (LEEPP): Clinically relevant or just academic?
Objective: The aim of this study was to assess oncological outcome in patients after R0/R1 resections in a homogenous cohort suffering from ductal adenocarcinoma (PDAC) of the pancreatic head.
Summary Background Data: Applying rigorous standardized histopathological protocols in the examination of resection specimens of PDAC of the pancreatic head reveals microscopic incomplete (R1) resection rates of up to and greater than 80%.
Methods: Between January 2007 and May 2011, 125 consecutive patients underwent surgical pancreaticoduodenectomy (PD) or pylorus-preserving PD because of PDAC of the pancreatic head. These patients were histopathologically examined according to a standardized protocol (Leeds Pathology Protocol LEEPP). The oncological outcome and clinicopathological data were compared to a matched patient group before implementing the abovementioned protocol (n = 108).
Results: The R1 rate increased significantly after implementing the LEEPP from 13 to 52%. A difference in overall survival (OS) could not be detected 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 to 18.1 months) vs. 22.2 months (7.8 – 36.7 months) (P = 0.046). Multivariate analysis revealed a margin clearance or 2 mm and more as independent prognosticator for OS:
Conclusions: With applying a standardized histopathological protocol, there was still no 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 changed in PAC.