Prospective Evaluation of Resection Margins Using Standardized Specimen Protocol Analysis among Patients with Distal Cholangiocarcinoma and Pancreatic Ductal Adenocarcinoma.

Purpose: Using a standardized specimen protocol analysis, this study aimed to evaluate the resection margin status of patients who underwent resection for either distal cholangiocarcinoma (DC) or pancreatic ductal adenocarcinoma (PDAC). This allowed a precise millimetric analysis of each inked margin.

Methods: From 2010 to 2018, 355 consecutively inked specimens from patients with PDAC ( = 288) or DC ( = 67) were prospectively assessed. We assessed relationships between the tumor and the following margins: transection of the pancreatic neck, bile duct, posterior surface, margin toward superior mesenteric artery, and the surface of superior mesenteric vein/portal vein groove. Resection margins were evaluated using a predefined cut-off value of 1 mm; however, clearances of 0 and 1.5 mm were also evaluated.

Results: Patients with DC were mostly men (64% vs. 49%, = 0.028), of older age (68 yo vs. 65, = 0.033), required biliary stenting more frequently (93% vs. 77%, < 0.01), and received less neoadjuvant treatment ( < 0.001) than patients with PDAC. The venous resection rate was higher among patients with PDAC ( = 0.028). Postoperative and 90-day mortality rates were comparable. Patients with PDAC had greater tumor size (28.6 vs. 24 mm, = 0.01) than those with DC. The R1 resection rate was comparable between the two groups, regardless of the clearance margin. Among the three types of resection margins, a venous groove was the most frequent in both entities. In multivariate analysis, the R1 resection margin did not influence patient survival in either PDAC or DC.

Conclusion: Our standardized specimen protocol analysis showed that the R1 resection rate was comparable in PDAC and DC.