Histopathological study: a key point in pancreatic cancer

Abstract

Introduction: R1 resection in pancreatoduodenectomy (PD) is a negative prognostic factor. Development of standardised pathologic protocols increased R1 rate and this can have implications in postoperative treatment strategy. Patients and methods: From 2000 we performed 243 PD. A total of 156 were due to pancreatic ductal adenocarcinoma. In May 2004 a new standardised anatomopathological protocol (SP) was introduced to evaluate resection's specimens (Verbeke Histopathology 2008). R1 was defined as presence of tumour cells at< 1mm from margin resection. Our series was divided in two groups: specimens studied with the old pathological protocol (NSP) with 93 cases) and SP group with72cases. There were no differences demographic data, tumour size, TNM staging, lymphadenectomy and positive lymph nodes. Results: There were no statistical differences in number of R1 pancreatic margins SP 7% vs NSP 3% or in R1 retroperitoneal margins (11% in both groups). More positive vascular margins were identified in SP group 25% vs 4% in NPS, P = 0.001. R1 circumferential margin was higher in SP group 32% vs 10% in NSP group, P = 0.001. 54% of patients in NSP received adjuvant chemotherapy vs 71% in SP group, P < 0.001 and 37% of patients in SP group received radiation as part of the adjuvant treatment vs 20% in NSP, P < 0.001. Survival rates at 2/ 5 years in SP were 91/39% respectively and in NSP group: 71/32% without statistical difference. Conclusions: Standardised pathologic study of PD specimens increased the rate of R1 margins and select patients suitable to more specific postoperative treatments.