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. 2023 Aug;30(8):5051-5060.
doi: 10.1245/s10434-023-13465-9. Epub 2023 May 20.

Nationwide Impact of Centralization, Neoadjuvant Therapy, Minimally Invasive Surgery, and Standardized Pathology Reporting on R0 Resection and Overall Survival in Pancreatoduodenectomy for Pancreatic Cancer

Simone Augustinus  1   2 , Pascale J M Schafrat  3   4 , Boris V Janssen  3   5   4 , Bert A Bonsing  6 , Lodewijk A A Brosens  7 , Olivier R Busch  3   4 , Stijn Crobach  8 , Michail Doukas  9 , Casper H van Eijck  10 , Lydia G M van der Geest  11 , Bas Groot Koerkamp  10 , Ignace H J T de Hingh  12 , G Mihaela Raicu  13 , Hjalmar C van Santvoort  14 , Marie-Louise van Velthuysen  9 , Joanne Verheij  5   4 , Marc G Besselink  15   16 , Arantza Farina Sarasqueta  17   18 ; Dutch Pancreatic Cancer Group
Affiliations

Nationwide Impact of Centralization, Neoadjuvant Therapy, Minimally Invasive Surgery, and Standardized Pathology Reporting on R0 Resection and Overall Survival in Pancreatoduodenectomy for Pancreatic Cancer

Simone Augustinus et al. Ann Surg Oncol. 2023 Aug.

Abstract

Background: Surgeons aim for R0 resection in patients with pancreatic cancer to improve overall survival. However, it is unclear whether recent changes in pancreatic cancer care such as centralization, increased use of neoadjuvant therapy, minimally invasive surgery, and standardized pathology reporting have influenced R0 resections and whether R0 resection remains associated with overall survival.

Methods: This nationwide retrospective cohort study included consecutive patients after pancreatoduodenectomy (PD) for pancreatic cancer from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Database (2009-2019). R0 resection was defined as > 1 mm tumor clearance at the pancreatic, posterior, and vascular resection margins. Completeness of pathology reporting was scored on the basis of six elements: histological diagnosis, tumor origin, radicality, tumor size, extent of invasion, and lymph node examination.

Results: Among 2955 patients after PD for pancreatic cancer, the R0 resection rate was 49%. The R0 resection rate decreased from 68 to 43% (2009-2019, P < 0.001). The extent of resections in high-volume hospitals, minimally invasive surgery, neoadjuvant therapy, and complete pathology reports all significantly increased over time. Only complete pathology reporting was independently associated with lower R0 rates (OR 0.76, 95% CI 0.69-0.83, P < 0.001). Higher hospital volume, neoadjuvant therapy, and minimally invasive surgery were not associated with R0. R0 resection remained independently associated with improved overall survival (HR 0.72, 95% CI 0.66-0.79, P < 0.001), as well as in the 214 patients after neoadjuvant treatment (HR 0.61, 95% CI 0.42-0.87, P = 0.007).

Conclusions: The nationwide rate of R0 resections after PD for pancreatic cancer decreased over time, mostly related to more complete pathology reporting. R0 resection remained associated with overall survival.

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Conflict of interest statement

No conflicts of interest declared.

Figures

Fig. 1
Fig. 1
5-year-survival rate for 2955 patients after pancreatoduodenectomy for pancreatic cancer. *Using the main study definition R0: according to 1mm tumor clearance
Fig. 2
Fig. 2
Annual R0 resection rates after pancreatoduodenectomy for pancreatic cancer, according to three most commonly used definitions for R0 resection. *Main study definition R0: according to 1 mm tumor clearance. Other used definitions: 0 mm tumor clearance and 1 mm tumor clearance, anterior surface included
See this image and copyright information in PMC

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