为研究基于修订后的 R 状态（1 mm）的 R0 或 R1 切除手术后，经新辅助治疗（NAT）的胰管腺癌（PDAC）患者的肿瘤学结果。修订后的 R 状态是直接切除 PDAC 的独立预后因素，但 NAT 后的 1 mm 边缘清除的意义仍存在争议。从两个前瞻性维护的数据库中识别接受 PDAC NAT 后胰腺切除术的患者。分析临床病理和生存数据。主要结果为总生存期（OS）、无复发生存期（RFS）和与 R0>1 mm 和 R1≤1 mm 切除相关的复发模式。NAT 后 PDAC 的 357 名患者经过胰腺切除术后纳入研究。208 名患者（58.3％）接受 FOLFIRINOX，41 名患者（11.5％）接受基于紫烷类的方案，299 名个体（83.8％）接受附加放射治疗。272 名患者（76.2％）达到 R0 切除，85 名患者（23.8％）达到 R1 切除。R0 切除后中位 OS 为 41.0 个月，而 R1 切除后为 20.6 个月（P = 0.002），在额外的辅助化疗后甚至更长（R0 44.8 个月 vs. R1 23.3 个月；P = 0.0032）。R0 亚组的中位 RFS 是 17.5 个月，而 R1 亚组为 9.4 个月（P <0.0001）。R 状态被证实是 OS（R1：HR 1.56，95％ CI 1.07-2.26）和 RFS（R1：HR 1.52；95％ CI 1.14-2.0）的独立预测因子。此外，R1 切除与局部而不是远端复发密切相关（P = 0.0005）。修订后的 R 状态是 NAT 后 PDAC 的切除术后生存和局部复发的独立预测因子。在 NAT 后 PDAC 手术治疗中，达到至少1 mm的 R0 切除应该是最主要的目标。版权所有 © 2023 作者。由 Wolters Kluwer Health, Inc. 发布。

To investigate the oncological outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) who had a R0 or R1 resection based on the revised R status (1 mm) after neoadjuvant therapy (NAT).The revised R status is an independent prognostic factor in upfront-resected PDAC; however, the significance of 1 mm margin clearance after NAT remains controversial.Patients undergoing pancreatectomy following NAT for PDAC were identified from two prospectively maintained databases. Clinicopathological and survival data were analyzed. The primary outcomes were overall survival (OS), recurrence-free survival (RFS), and pattern of recurrence in association with R0>1 mm and R1≤1 mm resections.Three hundred fifty-seven patients with PDAC were included after NAT and subsequent pancreatic resection. Two hundred eight patients (58.3%) received FOLFIRINOX, 41 patients (11.5%) gemcitabine-based regimens, and 299 individuals (83.8%) received additional radiotherapy. R0 resections were achieved in 272 patients (76.2%) and 85 patients (23.8%) had R1 resections. Median OS after R0 was 41.0 months, compared with 20.6 months after R1 resection (P=0.002) and even longer after additional adjuvant chemotherapy (R0 44.8 mo vs. R1 23.3 mo; P=0.0032). Median RFS in the R0 subgroup was 17.5 months versus 9.4 months in the R1 subgroup (P<0.0001). R status was confirmed as an independent predictor for OS (R1: HR 1.56, 95% CI 1.07-2.26) and RFS (R1: HR 1.52; 95% CI 1.14-2.0). In addition, R1 resections were significantly associated with local but not distant recurrence (P=0.0005).The revised R status is an independent predictor of postresection survival and local recurrence in PDAC after NAT. Achieving R0 resection with a margin of at least 1 mm should be a primary goal in the surgical treatment of PDAC after NAT.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.