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R0 Resection improves survival after multivisceral resection for pancreatic ductal adenocarcinoma

Rebelo, Artur ; Andersson, Bodil LU orcid ; Bandyopadhyay, Samik Kumar ; Bereza-Carlson, Paulina LU orcid ; Berrevoet, Frederik ; Björnsson, Bergthor ; Bouwense, Stefan ; Bergquist, Erik ; Bösch, Florian and Büchler, Markus , et al. (2026) In iScience 29(9). p.1-12
Abstract
Achieving negative resection margins (R0) is central to curative surgery for pancreatic ductal adenocarcinoma (PDAC), but its prognostic relevance in multivisceral resections has been unclear. Using the largest international registry of multivisceral pancreatic resections, we performed a propensity score-matched analysis comparing R0 and R1 resections in patients undergoing multivisceral resection for PDAC. After 1:1 matching on pre- and intra-operative covariates, 222 patients were analyzed (111 R0, 111 R1). Perioperative morbidity, 90-day mortality, and intraoperative complications were comparable between groups. Median overall survival was 22.3 months after R0 resection versus 14.5 months after R1 resection; R1 status remained... (More)
Achieving negative resection margins (R0) is central to curative surgery for pancreatic ductal adenocarcinoma (PDAC), but its prognostic relevance in multivisceral resections has been unclear. Using the largest international registry of multivisceral pancreatic resections, we performed a propensity score-matched analysis comparing R0 and R1 resections in patients undergoing multivisceral resection for PDAC. After 1:1 matching on pre- and intra-operative covariates, 222 patients were analyzed (111 R0, 111 R1). Perioperative morbidity, 90-day mortality, and intraoperative complications were comparable between groups. Median overall survival was 22.3 months after R0 resection versus 14.5 months after R1 resection; R1 status remained independently associated with poorer survival after adjustment for residual imbalances (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.02–2.07). Margin-negative resection is associated with improved long-term survival in multivisceral pancreatic surgery without an accompanying increase in perioperative risk, supporting R0 resection as a goal of surgical strategy at specialized centers. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
iScience
volume
29
issue
9
article number
117352
pages
1 - 12
publisher
Elsevier
ISSN
2589-0042
DOI
10.1016/j.isci.2026.117352
language
English
LU publication?
yes
id
ba8e3116-00d0-427c-9f6a-40e03f0939b1
date added to LUP
2026-09-02 05:55:00
date last changed
2026-09-02 07:40:49
@article{ba8e3116-00d0-427c-9f6a-40e03f0939b1,
  abstract     = {{Achieving negative resection margins (R0) is central to curative surgery for pancreatic ductal adenocarcinoma (PDAC), but its prognostic relevance in multivisceral resections has been unclear. Using the largest international registry of multivisceral pancreatic resections, we performed a propensity score-matched analysis comparing R0 and R1 resections in patients undergoing multivisceral resection for PDAC. After 1:1 matching on pre- and intra-operative covariates, 222 patients were analyzed (111 R0, 111 R1). Perioperative morbidity, 90-day mortality, and intraoperative complications were comparable between groups. Median overall survival was 22.3 months after R0 resection versus 14.5 months after R1 resection; R1 status remained independently associated with poorer survival after adjustment for residual imbalances (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.02–2.07). Margin-negative resection is associated with improved long-term survival in multivisceral pancreatic surgery without an accompanying increase in perioperative risk, supporting R0 resection as a goal of surgical strategy at specialized centers.}},
  author       = {{Rebelo, Artur and Andersson, Bodil and Bandyopadhyay, Samik Kumar and Bereza-Carlson, Paulina and Berrevoet, Frederik and Björnsson, Bergthor and Bouwense, Stefan and Bergquist, Erik and Bösch, Florian and Büchler, Markus and Chatzizacharias, Nikolaos and Coubeau, Laurent and Crede, Marie and Pathirannehalage Don, Cristine B. and Dries, Pieter and Erkan, Mert and Felsenstein, Matthäus and Frigerio, Isabella and Giardino, Alessandro and Glowka, Tim and Hadesi, Parsa and Hartman, Vera and Johansen, Karin and Klein, Marie and Klose, Johannes and Knipper, Karl and Leonhardt, Carl-Stephan and Loos, Martin and Malinka, Thomas and Marchegiani, Giovanni and Månsson, Christopher and Pellegrini, Riccardo and Perri, Giampaolo and Poelsler, L.H. and Roeyen, Geert and Rousek, Michael and Sancho, Pablo and Schild-Suhren, Stina and Schmidt, Thomas and Serrablo, Leyre and Serrablo, Alejandro and Smith, Andrew Malvern and Stavrou, Gregor A. and Strobel, Oliver and Shrikhande, Shailesh and Strobel, Alexandra and Tarantino, Ignazio and Urdzik, Jozef and Vilz, Tim and Vella, Roberta and Wennerblom, Johanna and Wyzlic, Patricia and Kleeff, Jörg}},
  issn         = {{2589-0042}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{9}},
  pages        = {{1--12}},
  publisher    = {{Elsevier}},
  series       = {{iScience}},
  title        = {{R0 Resection improves survival after multivisceral resection for pancreatic ductal adenocarcinoma}},
  url          = {{http://dx.doi.org/10.1016/j.isci.2026.117352}},
  doi          = {{10.1016/j.isci.2026.117352}},
  volume       = {{29}},
  year         = {{2026}},
}