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Simple Summary: This study investigates the impact of resection margin (R) status on overall survival (OS) and disease-free survival (DFS) in patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). A retrospective analysis of 167 PD cases from 2012 to 2023 revealed that 62.8% achieved negative margins (R0), while 37.1% had positive margins (R1). Patients with R1 status had significantly lower OS (23 vs. 36 months, p = 0.003) and DFS (10 vs. 18 months, p = 0.004) compared to R0 patients. Multivariate analysis identified R1 status and positive lymph nodes (N+) as independent factors adversely affecting both OS and DFS. Specifically, among patients with N+ disease, R1 status was associated with a notably decreased DFS (10 vs. 16 months, p = 0.05). The study concludes that achieving R0 status during PD is crucial for improved long-term outcomes, emphasizing the importance of radical surgery, especially in patients with lymph node involvement. The influencing role of resection margin (R) status on long-term outcomes, namely overall (OS) and disease-free survival (DFS), after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is not still clear. The aim of this study is to evaluate the prognostic impact of R status after PD and to define tumor characteristics associated with a positive resection margin (R1). All PDs for PDAC performed between 2012 and 2023 were retrospectively enrolled. The effect of R status, patient clinico-demographic features, and tumor features on OS and DFS were assessed. One-hundred and sixty-seven patients who underwent PD for PDAC were included in the study. R0 was achieved in 105 cases (62.8%), while R1 was evidenced in 62 patients (37.1%). R1 was associated with a decreased OS (23 (13–38) months) as compared to R0 (36 (21–53) months) (p = 0.003). Similarly, DFS was shorter in R1 patients (10 (6–25) months) as compared to the R0 cohort (18 (9–70) months) (p = 0.004), with a consequent higher recurrence rate in cases of R1 (74.2% vs. 64.8% in the R0 group; p = 0.04). In the multivariate analysis, R1 and positive lymph nodes (N+) were the only independent influencing factors for OS (OR: 1.6; 95% CI: 1–2.5; p = 0.03 and OR: 1.7; 95% CI: 1–2.8; p = 0.04) and DFS (OR: 1.5; 95% CI: 1–2.1; p = 0.04 and OR: 1.8; 95% CI: 1.1–2.7; p = 0.009). Among 111 patients with N+ disease, R1 was associated with a significantly decreased DFS (10 (8–11) months) as compared to R0N+ patients (16 (11–21) months) (p = 0.05). In conclusion, the achievement of a negative resection margin is associated with survival benefits, particularly in cases of N1 disease. In addition, R0 was recognized as an independent prognostic feature for both OS and DFS. This further outlines the relevant role of radical surgery on long-term outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Pancreatic cancer is a devasting disease that has unfortunately proven very difficult to treat. Exploring new therapeutic options and getting an early diagnosis is crucial to improve the outcomes for those affected. Studying the intestinal, pancreatic, and oral microbiota offers exciting perspectives to understand the development of pancreatic cancer better. Particular expressions of the microbiota could help both for early diagnosis and for predicting the response to chemotherapy or immunotherapy. This area of research is very promising; therefore, further studies are needed to increase the available data. Pancreatic cancer (PC) has an unfavorable prognosis with few effective therapeutic options. This has led researchers to investigate the possible links between microbiota and PC. A disrupted gut microbiome can lead to chronic inflammation, which is involved in the pathogenesis of PC. In addition, some bacterial strains can produce carcinogens that promote the growth of cancer cells. Research has also focused on pancreatic and oral microbiota. Changes in these microbiota can contribute to the development and progression of PC. Furthermore, patients with periodontal disease have an increased risk of developing PC. The potential use of microbiota as a prognostic marker or to predict patients' responses to chemotherapy or immunotherapy is also being explored. Overall, the role of microbiota—including the gut, pancreatic, and oral microbiota—in PC is an active research area. Understanding these associations could lead to new diagnostic and therapeutic targets for this deadly disease. [ABSTRACT FROM AUTHOR]