Prognostic impact of CRM-status on survival in patients with resected pancreatic adenocarcinoma - a dual-center cohort analysis.
[BACKGROUND] This study aimed to evaluate the impact of circumferential resection margin (CRM) status on the prognosis of patients undergoing pancreatic head resection for pancreatic adenocarcinoma (P
- p-value p < 0.001
- HR 1.5
- 연구 설계 cohort study
APA
Brunner M, Merkel S, et al. (2026). Prognostic impact of CRM-status on survival in patients with resected pancreatic adenocarcinoma - a dual-center cohort analysis.. Surgical oncology, 66, 102422. https://doi.org/10.1016/j.suronc.2026.102422
MLA
Brunner M, et al.. "Prognostic impact of CRM-status on survival in patients with resected pancreatic adenocarcinoma - a dual-center cohort analysis.." Surgical oncology, vol. 66, 2026, pp. 102422.
PMID
41990518
Abstract
[BACKGROUND] This study aimed to evaluate the impact of circumferential resection margin (CRM) status on the prognosis of patients undergoing pancreatic head resection for pancreatic adenocarcinoma (PDAC).
[METHODS] In this dual-center retrospective cohort study, data from 413 patients who underwent curative-intent pancreatic head resection for PDAC between 2010 and 2023 at two German tertiary care centers were analyzed. CRM status was stratified into R0 wide (>1 mm), R0 narrow (≤1 mm) and R1 (tumor at margin). To account for potential confounding by tumor biology, a propensity score matching analysis was additionally performed comparing R0 wide versus R0 narrow/R1 resections.
[RESULTS] Among 413 patients, 208 (50%) had R0 wide, 126 (31%) R0 narrow and 79 (19%) R1 resections. Median overall survival (OS) was significantly longer in the R0 wide group (31 months) compared to R0 narrow (21 months) and R1 (20 months) (p < 0.001). Similarly, disease free survival (DFS) was significantly prolonged in R0 wide patients (21 months) versus R0 narrow (12 months) and R1 (12 months) (p < 0.001). Multivariate analysis identified CRM status as an independent prognostic factor for both OS (HR for R0 narrow: 1.4; R1: 1.5) and DFS (HR for R0 narrow: 1.4; R1: 1.4). These findings were confirmed after matching, with R0 wide resections remaining significantly associated with improved OS (HR: 1.5) and DFS (HR: 1.4). The most common localization of CRM narrow or R1 resections was the mesenteric vessel plane and dorsal margin, accounting for 64% of all positive or close margins.
[CONCLUSION] Achieving a margin clearance of >1 mm in resected pancreatic head adenocarcinoma is associated with significantly improved survival outcomes. The frequent involvement of the mesenteric and dorsal planes underscores the need for meticulous surgical technique and planning in these critical anatomical regions.
[METHODS] In this dual-center retrospective cohort study, data from 413 patients who underwent curative-intent pancreatic head resection for PDAC between 2010 and 2023 at two German tertiary care centers were analyzed. CRM status was stratified into R0 wide (>1 mm), R0 narrow (≤1 mm) and R1 (tumor at margin). To account for potential confounding by tumor biology, a propensity score matching analysis was additionally performed comparing R0 wide versus R0 narrow/R1 resections.
[RESULTS] Among 413 patients, 208 (50%) had R0 wide, 126 (31%) R0 narrow and 79 (19%) R1 resections. Median overall survival (OS) was significantly longer in the R0 wide group (31 months) compared to R0 narrow (21 months) and R1 (20 months) (p < 0.001). Similarly, disease free survival (DFS) was significantly prolonged in R0 wide patients (21 months) versus R0 narrow (12 months) and R1 (12 months) (p < 0.001). Multivariate analysis identified CRM status as an independent prognostic factor for both OS (HR for R0 narrow: 1.4; R1: 1.5) and DFS (HR for R0 narrow: 1.4; R1: 1.4). These findings were confirmed after matching, with R0 wide resections remaining significantly associated with improved OS (HR: 1.5) and DFS (HR: 1.4). The most common localization of CRM narrow or R1 resections was the mesenteric vessel plane and dorsal margin, accounting for 64% of all positive or close margins.
[CONCLUSION] Achieving a margin clearance of >1 mm in resected pancreatic head adenocarcinoma is associated with significantly improved survival outcomes. The frequent involvement of the mesenteric and dorsal planes underscores the need for meticulous surgical technique and planning in these critical anatomical regions.