Verbeke C S, Leitch D, Menon K V, McMahon M J, Guillou P J, Anthoney A
Department of Histopathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Br J Surg. 2006 Oct;93(10):1232-7. doi: 10.1002/bjs.5397.
Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status.
A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. R1 resection was defined as tumour within 1 mm of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non-standardized protocol was used (NSP series, n = 48).
Implementation of the SP resulted in a higher R1 rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0.001), but not for the NSP series. There was a trend towards better median and actuarial 5-year survival after R0 resection in the SP pancreatic cancer subgroup.
Standardized examination influences the reporting of RM status.
胰头腺癌的切缘（RM）状态通过组织学评估，但病理检查并不规范。本研究的目的是评估标准化病理检查对RM状态报告的影响。
制定了一项用于胰十二指肠切除术标本检查的标准化方案（SP），包括多色切缘染色、轴向切片和广泛的组织取样。R1切除定义为肿瘤距RM 1 mm以内。将根据该方案报告的前瞻性系列（SP系列，n = 54）与使用非标准化方案的历史匹配系列（NSP系列，n = 48）进行比较。
实施SP总体上导致R1率更高，与壶腹癌（15例中的4例）和胆管癌（13例中的6例）相比，胰腺癌的R1率更高（26例中的22例，85%）。SP系列中对环周RM的取样更广泛，且与RM状态相关。RM受累通常为多灶性（32例中的14例），最常累及后RM（32例中的21例）。整个SP系列的生存与RM状态相关（P < 0.001），但NSP系列并非如此。在SP胰腺癌亚组中，R0切除后中位生存期和5年精算生存率有改善趋势。
标准化检查影响RM状态的报告。
