Dramatic Survival Benefit Related to R0 Resection of Pancreatic Adenocarcinoma in Patients With Tumor ≤ 25 mm in Size and ≤ 1 Involved Lymph Nodes

OBJECTIVES: To evaluate i) the relative importance of R0 resection, tumor size and peripancreatic lymph node (LN) status are significant determinants of survival benefit following upfront surgery for pancreatic adenocarcinoma (PaCa), ii) whether R0 resection confers survival benefit in all patients or a patient subset with certain favorable prognostic factors. METHODS: Retrospective analysis of patients (2001-2010) who underwent planned potentially curative surgical resection without neoadjuvant therapy for PaCa. RESULTS: Among 154 patients, median survival following R0 (n = 105) and R1 resections was 26.8 and 17.7 months, respectively (P = 0.010). Tumor size and LN status were significant determinants of survival following R0 resection. There were no differences in survival based on tumor size and LN in patients with R1 resection. Median survival was 17.7 months following R1 resection and was 70.9 months (P < 0.001) and 22.2 months (P = 0.44) in patients with tumor <= 25 mm in size and <= 1 involved LN and in the remaining patients in the cohort respectively following R0 resection. CONCLUSIONS: R0 resection is associated with dramatic survival benefit over R1 resection in a subset of patients with tumor size <= 25 mm and <= 1 involved LN. These findings underscore the importance of R0 resection and careful patient selection for upfront surgery in patients with PaCa.