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Invited Critique |

Influence of Resection Margins and Treatment on Survival in Patients With Pancreatic Cancer—Invited Critique

Charles D. Mabry, MD
Arch Surg. 2008;143(1):83. doi:10.1001/archsurg.2007.18.
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Cancer of the pancreas is no disease for wimps. Carcinoma of the pancreas is increasing in incidence and ranks as the fourth leading cancer death in the United States. Indeed, this is one of the more deadly diseases, as can be seen by the close similarity of incidence and death statistics for the disease: in the United States in 2006 there were 33 730 new cases of the disease and 32 300 deaths.1

The article by Butturini et al details the interaction of postoperative adjuvant therapy on survival in 875 patients with pancreatic cancer at various TNM stages. Patients were found to have either no disease (R0) or microscopic residual disease (R1) at the resection margin. This is a follow-up statistical analysis of a meta-analysis from 4 major study groups2 and was organized to decide whether R1 patients should be included in a subgroup of R0 patients or whether they should be a separate category for purposes of treatment. In other words, do positive margins make a difference in postsurgical treatment or outcomes?

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