Assessment of Standardization Circumferential Resection Margin Status Influence Survival following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Abstract Background: Not only to assess the prognostic influence on standardization circumferential resection margin R0 and R1 Status but also to research the prognostic influence on adjuvant chemotherapy to PV/SMV, SMA resection margins﹤1mm. The SMV and SMA resection margins had an important prognostic influence to PDAC patients, and the survival prognosis of R1 status(resection margin﹤1mm) was poor. Methods: A total of 228 patients performed PD between 2015 and 2019 were included, which was assessment of standardization circumferential resection margin status and survival prognosis. There were cancer cells within 1mm clearance of PV/SMV and SMA resection margins named R1 PV/SMV, SMA, and no cancer cells named R0 PV/SMV, SMA.Results: The resection margin 1mm clearance of PV/SMV, SMA (P=0.010) and postoperative adjuvant chemotherapy (P=0.001) were prognostic independent predictors. The median survival time was 22 months of 166 R0 PV/SMV, SMA patients (73%) compared to 15 months of 62 R1 PV/SMV, SMA patients (27%) (P=0.005). There was the statistical significance of survival time between the adjuvant chemotherapy group and the none-adjuvant chemotherapy group (P=0.000). In the R1 PV/SMV, SMA group, there was no statistical significance of survival time between the adjuvant chemotherapy patients and the none-adjuvant chemotherapy patients (P=0.208).Conclusions: Patients undergoing PD for PDAC, postoperative adjuvant chemotherapy could not improve the poor survival prognosis of R1 PV/SMV, SMA resection patients. The resection margins of PV/SMV, SMA had a greater prognostic influence on survival than postoperative adjuvant chemotherapy.Trial registration: Clinicaltrials.gov/ct2/show/NCT02928081