Experts Highlight Importance of Achieving R0 Resections in Cancer Surgery


Positive margin rates have not appeared to improve for patients with cancer undergoing surgical care based on several prior studies.

In a conversation with CancerNetwork®, Kamran Idrees, MD, MSCI, MMHC, FACS; Natalie A. Lockney, MD; and Milad Baradaran, PhD, DABR, discussed the potential applications and benefits of intraoperative radiation therapy (IORT) as a treatment strategy for those with pancreatic cancer.

Idrees, chief in the Division of Surgical Oncology & Endocrine Surgery, an associate professor of Surgery, an Ingram Associate Professor of Cancer Research, and director of Pancreatic and Gastro-Intestinal Surgical Oncology at Vanderbilt University Medical Center, contextualized the discussion by highlighting the importance of achieving negative margin resections during surgery. He also described how factors such as tumor location may prevent surgeons from achieving these outcomes.

According to Idrees, findings from prior studies have shown that the rates of positive margin resections have not improved over time, resulting in diminished overall survival for patients. He suggested that IORT may address this issue to improve treatment outcomes.


The goal of cancer surgery is to remove all the cancer; that is, to achieve a negative margin and offer a chance for a cure. In most cases, we’re able to achieve negative margins or R0 resection. However, there are instances in which we are not able to achieve negative margins because it’s either not technically feasible based on the location of the tumor or involvement of key anatomical structures, or sometimes the morbidity of the more radical surgery to achieve negative margins. This will result in microscopic or macroscopic resection or, in other words, positive resection margins.

There have been several studies done across multiple cancers including prostate, pancreatic, head and neck, and colorectal cancer that have utilized large national databases looking at margin positivity over a span of several years such as greater than 10 years. [The studies] have consistently shown that the positive margin rates have not improved. Why are positive surgical margins important? It results in an increased rate of local recurrence, increased cost of care, as well as treatment intensification. All those results in decreased overall survival. To address this issue of positive margins is where the role of intraoperative radiation therapy comes in.

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