Prognostic Value of a ≥ 1000 μm Posterior Margin After Gerota's Fascia Resection in Distal Pancreatectomy for Resectable Pancreatic Cancer: A Single-Center Retrospective Study.

Abstract

Radical antegrade modular pancreatosplenectomy (RAMPS) enables posterior dissection along Gerota's fascia, contributing to improved R0 resection rates, lymphadenectomy, and overall survival (OS) in pancreatic body and tail cancers. Although a posterior margin ≥ 1000 μm has been associated with better prognosis, its relative impact compared with Gerota's fascia resection remains unclear. This study evaluated whether securing a posterior margin ≥ 1000 μm improves outcomes in patients undergoing Gerota's fascia resection for pancreatic body and tail cancer. This retrospective study included 93 patients who underwent distal pancreatectomy with Gerota's fascia resection for resectable pancreatic cancer without adrenal or kidney invasion (2014-2022). Clinical data, recurrence-free survival (RFS), and OS were compared between patients with posterior margins < 1000 μm and ≥ 1000 μm. Multivariate regression analysis identified independent predictors of recurrence. Of 93 patients, 21 (23%) had posterior margins < 1000 μm and 72 (77%) had margins ≥ 1000 μm. OS and recurrence rates at 1, 3, and 5 years were comparable between the < 1000 μm and ≥ 1000 μm groups, with no significant differences (OS: 85%, 63%, 51% vs. 93%, 68%, 53%, p = 0.65; recurrence: 7.0%, 33.5%, 59.1% vs. 19.0%, 44.4%, 66.6%, p = 0.30). Multivariate analysis identified four or more positive lymph nodes, splenic vessel invasion, and elevated tumor markers as independent recurrence risk factors. In resectable pancreatic cancer without adrenal or kidney invasion, a posterior margin ≥ 1000 μm was not associated with improved survival, supporting the adequacy of this approach. Further investigation into systemic disease control via preoperative chemotherapy is warranted.