胰十二指肠切除术治疗导管腺癌：切缘阳性对生存的影响

Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival.

作者信息

Fatima Javairiah, Schnelldorfer Thomas, Barton Joshua, Wood Christina M, Wiste Heather J, Smyrk Thomas C, Zhang Lizhi, Sarr Michael G, Nagorney David M, Farnell Michael B

机构信息

Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.

出版信息

Arch Surg. 2010 Feb;145(2):167-72. doi: 10.1001/archsurg.2009.282.

DOI:10.1001/archsurg.2009.282

PMID:20157085

Abstract

OBJECTIVE

To assess the effect of R0 resection margin status and R0 en bloc resection in pancreatoduodenectomy outcomes.

DESIGN

Retrospective medical record review.

SETTING

Mayo Clinic, Rochester, Minnesota.

PATIENTS

Patients who underwent pancreatoduodenectomy for pancreatic adenocarcinoma at our institution between January 1, 1981, and December 31, 2007, were identified and their medical records were reviewed.

MAIN OUTCOME MEASURE

Median survival times.

RESULTS

A total of 617 patients underwent pancreatoduodenectomy. Median survival times after R0 en bloc resection (n = 411), R0 non-en bloc resection (n = 57), R1 resection (n = 127), and R2 resection (n = 22) were 19, 18, 15, and 10 months, respectively (P < .001). A positive resection margin was associated with death (P = .01). No difference in survival time was found between patients undergoing R0 en bloc and R0 resections after reexcision of an initial positive margin (hazard ratio, 1.19; 95% confidence interval, 0.87-1.64; P = .28).

CONCLUSIONS

R0 resection remains an important prognostic factor. Achieving R0 status by initial en bloc resection or reexcision results in similar long-term survival.

摘要

目的

评估R0切缘状态和R0整块切除对胰十二指肠切除术预后的影响。

设计

回顾性病历审查。

地点

明尼苏达州罗切斯特市梅奥诊所。

患者

确定了1981年1月1日至2007年12月31日期间在本机构接受胰腺癌胰十二指肠切除术的患者，并对其病历进行了审查。

主要观察指标

中位生存时间。

结果

共有617例患者接受了胰十二指肠切除术。R0整块切除（n = 411）、R0非整块切除（n = 57）、R1切除（n = 127）和R2切除（n = 22）后的中位生存时间分别为19个月、18个月、15个月和10个月（P <.001）。切缘阳性与死亡相关（P =.01）。在初次切缘阳性后再次切除的患者中，R0整块切除和R0切除的患者生存时间无差异（风险比，1.19；95%置信区间，0.87 - 1.64；P =.28）。