Radical resection (RAMPS) of left-sided pancreatic ductal adenocarcinoma (PDAC) is useful in achieving R0 margins; however, it is not universally accepted due to a lack of improved survival. A recent study hypothesized that only larger tumors cause R1 in non-RAMPS procedures.

It performed a retrospective review of charts between 2008 and 2020; and evaluated the primary outcome of R0 resection based on left-sided tumors′ size and location, and secondary outcomes of disease-free survival (DFS) and overall survival (OS).

• The study enrolled sixty-eight percent who had R0 resection.
• R1 group showed larger tumors (5.5 cm vs. 3.8 cm) and higher LVI involvement.
• OS and DFS showed similarities in the multivariate analysis.
• Tumor size above 4 cm in the tail showed association with R1.

This study indicates that larger tumors in the tail but not the body are associated with R1 but not worse survival. Possibly larger tumors in the tail are a surrogate marker of poor disease biology.

Cadili L, Vasilyeva E, Li J, Kim P, Chung S, Segedi M. Pancreas tail adenocarcinoma tumor size is highly predictive of positive margins after a nonradical resection. Am J Surg. 2022 Aug;224(2):728-732. doi: 10.1016/j.amjsurg.2022.05.021. Epub 2022 May 23. PMID: 35643634.