Originally published as JCO Early Release 10.1200/JCO.2008.20.5104 on April 27 2009

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Margin Clearance and Outcome in Resected Pancreatic Cancer

Cancer Research Program, Garvan Institute of Medical Research, Sydney; Departments of Surgery and Gastroenterology, Bankstown Hospital, University of New South Wales, Bankstown; Department of Anatomical Pathology, Royal North Shore Hospital, University of Sydney, St Leonards; Department of Surgery, Liverpool Hospital, Liverpool; and Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Corresponding author: Andrew V. Biankin, BMedSc, MBBS, FRACS, PhD, Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, New South Wales, Australia, 2010; e-mail: a.biankin{at}garvan.org.au.

Purpose Current adjuvant therapies for pancreatic cancer (PC) are inconsistently used and only modestly effective. Because a high proportion of patients who undergo resection for PC likely harbor occult metastatic disease, any adjuvant trials assessing therapies such as radiotherapy directed at locoregional disease are significantly underpowered. Stratification based on the probability (and volume) of residual locoregional disease could play an important role in the design of future clinical trials assessing adjuvant radiotherapy.

Patients and Methods We assessed the relationships between margin involvement, the proximity to operative resection margins and outcome in a cohort of 365 patients who underwent operative resection for PC.

Results Microscopic involvement of a resection margin by tumor was associated with a poor prognosis. Stratifying the minimum clearance of resection margins by 0.5-mm increments demonstrated that although median survival was no different to clear margins based on these definitions, it was not until the resection margin was clear by more than 1.5 mm that optimal long-term survival was achieved.

Conclusion These data demonstrate that a margin clearance of more than 1.5 mm is important for long-term survival in a subgroup of patients. More aggressive therapeutic approaches that target locoregional disease such as radiotherapy may be beneficial in patients with close surgical margins. Stratification of patients for entry onto future clinical trials based on this criterion may identify those patients who benefit from adjuvant radiotherapy.

Supported by The National Health and Medical Research Council of Australia, The Cancer Council New South Wales, Cancer Institute New South Wales, the Royal Australasian College of Surgeons, and the R. T. Hall Trust.

Written on behalf of the New South Wales Pancreatic Cancer Network.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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