Kolb A, Kleeff J, Friess H, Büchler M W
Chirurgische Klinik, Universität Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Chirurg. 2007 Sep;78(9):802-9. doi: 10.1007/s00104-007-1377-6.
Macroscopic and microscopic complete resection, i.e. R0 resection, is a basic principle of oncologic hepatopancreatobiliary (HPB) surgery. The reported R1 rates for different HPB tumor entities vary considerably, most likely because of ambiguities in the exact definition of R1 resection and the lack of standardized histopathologic examination and reporting. R1 resections can be interpreted as technical/surgical failure (e.g. for small, peripherally located liver tumors). In most cases, however, R1 resections are determined by the anatomic location of the tumor and the growth pattern (e.g. pancreatic cancer with perineural invasion). R0 resections have been identified as positive predictive markers for several HPB tumors (in comparison to R1 resection). Therefore HPB surgeons should always aim at macroscopic and microscopic complete resections. Nonetheless, R1 resections often provide an advantage over no resection with respect to survival and quality of life in patients with these tumors.
宏观和微观层面的完整切除，即R0切除，是肿瘤性肝胰胆（HPB）外科手术的基本原则。不同HPB肿瘤实体报告的R1切除率差异很大，这很可能是由于R1切除的确切定义不明确以及缺乏标准化的组织病理学检查和报告。R1切除可被解释为技术/手术失败（例如对于小的、位于周边的肝肿瘤）。然而，在大多数情况下，R1切除是由肿瘤的解剖位置和生长模式决定的（例如伴有神经周围浸润的胰腺癌）。R0切除已被确定为几种HPB肿瘤的阳性预测标志物（与R1切除相比）。因此，HPB外科医生应始终致力于宏观和微观层面的完整切除。尽管如此，对于这些肿瘤患者，R1切除在生存和生活质量方面通常比不切除更具优势。
