Kato Koichi, Yamada Suguru, Sugimoto Hiroyuki, Kanazumi Naohito, Nomoto Shuji, Takeda Shin, Kodera Yasuhiro, Morita Satoshi, Nakao Akimasa
Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Pancreas. 2009 Aug;38(6):605-12. doi: 10.1097/MPA.0b013e3181a4891d.
Although a positive resection margin has been reported to be a strong prognostic factor after resection for pancreatic cancer, several studies indicated that resection status did not independently affect survival. The aim of this study was to examine the influence of resection margin status on survival after extended radical resection for pancreatic head cancer.
One hundred thirty-eight cases of pancreatoduodenectomy and 38 cases of pylorus-preserving pancreatoduodenectomy for invasive ductal carcinoma of the pancreas were retrospectively analyzed.
The resection margins were negative (R0) in 115 patients (65.3%), microscopically positive (R1) in 38 patients (21.6%), and grossly positive (R2) in 23 patients (13.1%). Patients with R1 resection survived significantly shorter (median survival time [MST], 9.4 months) than R0 resection patients (MST, 15.2 months) but survived longer than R2 resection patients (MST, 6.2 months). By multivariate analysis, R2 resection, together with lymph node metastasis, portal venous system, and extrapancreatic nerve plexus invasions, independently affected the overall survival, but R1 resection was not significantly influential.
R2 resection was an independent predictor of poor prognosis after pancreatoduodenectomy/pylorus-preserving pancreatoduodenectomy, whereas R1 resection did not independently affect the survival.
尽管有报道称切缘阳性是胰腺癌切除术后的一个强有力的预后因素，但多项研究表明切除状态并非独立影响生存率。本研究的目的是探讨切缘状态对胰头癌扩大根治性切除术后生存率的影响。
回顾性分析138例因胰腺浸润性导管癌行胰十二指肠切除术和38例行保留幽门的胰十二指肠切除术的病例。
115例患者（65.3%）切缘阴性（R0），38例患者（21.6%）镜下阳性（R1），23例患者（13.1%）肉眼阳性（R2）。R1切除患者的生存时间明显短于R0切除患者（中位生存时间[MST]，9.4个月），但长于R2切除患者（MST，6.2个月）。多因素分析显示，R2切除连同淋巴结转移、门静脉系统和胰外神经丛侵犯独立影响总生存，但R1切除无显著影响。
R2切除是胰十二指肠切除术/保留幽门的胰十二指肠切除术后预后不良的独立预测因素，而R1切除并不独立影响生存。
