Departments of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Pancreas. 2012 Jul;41(5):753-8. doi: 10.1097/MPA.0b013e31823b12a4.
The aims of this study were to clarify the type of intrapancreatic spread of cancer of the pancreatic body and tail and to assess whether a 2-cm transection margin is adequate to ensure negative margins.
We selected 66 patients who underwent distal pancreatectomy for cancer of the pancreatic body and tail. We investigated intrapancreatic cancer spread in these patients histopathologically and analyzed the relationship between 2-cm-margin positivity and other clinicopathological characteristics.
Two-centimeter-margin positivity was observed in 17 cases. In these, tumors had a tendency to spread toward the pancreatic head along the main pancreatic duct. As a result of statistical analysis, we considered venous invasion (odds ratio [OR], 15.48; 95% confidence interval [CI], 1.61-148.94; P = 0.0177), 2-cm-margin fibrosis (OR, 173.88; 95% CI, 8.96-3375.03; P = 0.0007), and 2-cm-margin hardness (OR, 5.97; 95% CI, 1.07-33.46; P = 0.0420) as being independently related to 2-cm-margin positivity.
The results suggest that 2 cm is not a safe length to ensure a negative margin. In the future, preoperative and intraoperative evaluation of the degree of fibrosis of pancreatic parenchyma could lead to cancer-free pancreatic cut-end margins.
本研究旨在阐明胰体尾部癌的胰内播散类型，并评估 2cm 的切缘是否足以确保阴性切缘。
我们选择了 66 例行胰体尾癌切除术的患者。我们从组织病理学角度研究了这些患者的胰内癌扩散情况，并分析了 2cm 切缘阳性与其他临床病理特征之间的关系。
17 例患者的 2cm 切缘阳性。在这些患者中，肿瘤有沿着主胰管向胰头方向扩散的趋势。通过统计学分析，我们认为静脉侵犯（比值比 [OR]，15.48；95%置信区间 [CI]，1.61-148.94；P=0.0177）、2cm 切缘纤维化（OR，173.88；95% CI，8.96-3375.03；P=0.0007）和 2cm 切缘硬度（OR，5.97；95% CI，1.07-33.46；P=0.0420）与 2cm 切缘阳性独立相关。
结果表明，2cm 不足以确保阴性切缘。未来，术前和术中评估胰腺实质纤维化程度可能会导致无癌胰腺切缘。
