IMPLEMENTATION OF LEEDS PROTOCOL (LEEPP) IN DUODENOPANCREATECTOMIES FOR PANCREATIC ADENOCARCINOMA AND IMPACT OF RESECTION MARGINS IN THE SURVIVAL Patricia Saez Carlin, Emmy Arrue del Cid, Elia Pérez Aguirre, Alejandra García Botella, Luis Díez Valladares, Antonio Torres García  LEEPP standardizes R1 resection as the presence of tumor within 1 mm of the resection margin:  redefines the resection margin.  increases R1 resections.  AIM to analyze the impact of resection margins in the survival of patients undergoing surgery for pancreatic head adenocarcinoma in our centre (2009-2014).

24 patients SEX

AGE

54,2% women 70,92 (ED+/- 10,66)

US ABDOMEN CT COLANGIO MRI CPRE ECOENDOSCOPY PROSTHESIS

70.3% 86.7% 23.3% 27.6% 13.3% 23.3%

ANTERIOR 1

Hb

13.02 (±1.41)

Total Bilirrubine

7.43 (±7.98)

Direct Bilirrubine

6.42 (±4.99)

Total Proteins

6.45 (±0.86)

Albumine

3.70 (±0.66)

Alcaline Fosfatase

462.76 (±354.82)

GGT

734.84 (±630.21)

CEA

4.87 (±4.97)

CA 19.9

1183.93 (±2129.3)

POSTERIOR 5 MESENTERIC VEIN 6

affected margins

71%

63,2% 48,6%

41,8%

p=0,04

global survival

disease free survival

R0-R1 global survival

31%

p=0,33

R0-R1 disease free survival

* R1 patients received adyuvant chemotherapy. **No significative differences insurvival analyzing tumor size and lymph nodes

CONCLUSIONS: The LEEPP is a useful tool. R1 patients have worse outcome than R0 even with adyuvant treatment. Eventhough R1 are tecnically resectable, a more agresive surgery will not improve the prognosis. New neoadjuvant and adjuvant therapeutic targets should be necessary. Ref: Redefining the R1 resection in pancreatic cancer. Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A.Br J Surg. 2006