Correlation between imaging and surgical margin status

Approximately 20%-25% of PDAC patients have either resectable or borderline resectable disease. Standard of care for resectable stage disease is upfront surgery, and while increasing numbers of borderline resectable patients are being treated with neoadjuvant therapy prior to surgery, many still do proceed to upfront resection. Notably, a large number of upfront resections are microscopically incomplete (R1), and one quarter of patients will develop disease recurrence within 6 months. R0 resection rate is an important prognostic factor, diminishing local and distant recurrence rates, hence improving survival and is the goal for pancreatic cancer surgery. Despite being considered resectable preoperatively, many patients return an R1 margin after resection, and this is likely more commonly the case for borderline resectable disease where the extent of disease at presentation is more advanced. Measures to improve local control and achieve R0 margins include preoperative radiotherapy, however this is uncommonly delivered in Australia. An understanding of the true number of R1 positive margins following resection for resectable and for borderline resectable pancreas cancer is lacking in Australia. As the SCANPatient clinical trial (SCANPatient Clinical Trial | Upper Gastrointestinal Cancer Registry (ugicr.org.au)) will routinely be collecting pathology reports for resection specimens, and systematically documenting resectability status on imaging preoperatively, this project aims to provide answers regarding true margin positive rates in Australia across up to 40 trial sites nationwide. Further subtle correlations to stratify peritumoural inflammatory change on CT imaging (in distinction from tumour infiltration) may also be possible from analysis of this large dataset. You will assist with coordinating with local research teams at trial sites, collecting and entering data, and help prepare reports and manuscripts for publications.