Prognostic impact of CRM-status on survival in patients with resected pancreatic adenocarcinoma – a dual-center cohort analysis

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). 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. 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 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. • CRM > 1 mm is an independent prognostic factor in PDAC. • R0 wide significantly improves OS and DFS vs. R0 narrow / R1. • Survival benefit persists after propensity score matching. • 64% of close/positive margins occur dorsally or mesenterically. • Meticulous surgery is key to achieving oncologic radicality.