R1 resection is linked to significantly worse survival in node-positive pancreatic ductal adenocarcinoma patients.

• R1 status increased the hazard of mortality by 38% (HR 1.38; 95% CI: 1.21-1.59).
• The overall R0 rate in node-positive cases was 61.1%, varying by adherence to the Royal College of Pathology guidelines.

R0 resection should remain a key goal in surgical planning for these patients until more robust evidence regarding R1’s implications emerges.

• R1 resections under RCP guidelines were associated with an HR of 1.25 for poorer outcomes.