ASO Author Reflections: Isolated Margin Positivity in Localized Pancreatic Ductal Adenocarcinoma and Operative Margin Revision

Retrospective analyses investigating intraoperative margin revision in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing pancreatectomy have yielded conflicting results.Some studies have reported that additional resection to achieve an R0 margin on permanent section was not associated with higher overall survival (OS) or recurrence-free survival (RFS). 1,2Other studies have suggested that intraoperative revision of positive neck margins may lead to prolonged survival. 3To date, no studies have examined the frequency of isolated margin positivity (IMP) in patients with localized PDAC who underwent pancreatectomy (pancreatoduodenectomy, distal pancreatectomy, or total pancreatectomy) and determined the fraction of patients that would potentially derive a survival benefit from revising positive neck or surgical margins; conceptually, these would be patients with no adverse pathologic features (nodal positivity, perineural invasion, and lymphovascular invasion) besides margin positivity, and revision of this isolated margin would result in absence of any adverse pathologic feature and theoretically higher survival.