肿瘤在中切缘浸润预示着胰头十二指肠切除术治疗胰腺导管腺癌的生存情况。
Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
机构信息
HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, UK.
出版信息
J Gastrointest Surg. 2012 Oct;16(10):1875-82. doi: 10.1007/s11605-012-1985-4. Epub 2012 Aug 10.
BACKGROUND
Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated.
METHODS
Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed.
RESULTS
For PDAC, the R1 rate was 57.1% (48/84) for any margin, 31.0% (26/84) for anterior surface, 42.9% (36/84) for posterior surface, 29.8% (25/84) for medial margin, and 7.1% (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17.2 vs. 28.7 months, P = 0.007 and 12.3 vs. 21.0 months, P = 0.019, respectively). For individual margins, only medial positivity had a significant impact on survival (13.8 vs. 28.0 months, P < 0.001), as opposed to involvement in the anterior (19.7 vs. 23.3 months, P = 0.187) or posterior margin (17.5 vs. 24.2 months, P = 0.104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P = 0.002, HR = 0.381; 95% CI 0.207-0.701).
CONCLUSION
The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.
背景
在胰十二指肠切除术（PD）治疗胰腺导管腺癌（PDAC）后，不同的手术切缘是否存在显微镜下肿瘤侵犯（R1）仍存在争议。
方法
从一个前瞻性数据库中检索了 2001 年至 2010 年间接受 PD 的 258 例患者的临床病理数据。评估了环周切缘（胰腺横断、内侧、后侧和前侧表面）的 R1 切除率及其对生存的预后影响。
结果
对于 PDAC，任何切缘的 R1 率为 57.1%（48/84），前侧表面为 31.0%（26/84），后侧表面为 42.9%（36/84），内侧缘为 29.8%（25/84），胰腺横断缘为 7.1%（3/84）。R1 切除的总生存期和无病生存期明显差于 R0 切除（17.2 与 28.7 个月，P=0.007 和 12.3 与 21.0 个月，P=0.019）。对于各个切缘，只有内侧阳性对生存有显著影响（13.8 与 28.0 个月，P<0.001），而前侧（19.7 与 23.3 个月，P=0.187）或后侧切缘（17.5 与 24.2 个月，P=0.104）则不然。多变量分析表明，R0 内侧切缘是独立的预后因素（P=0.002，HR=0.381；95%CI 0.207-0.701）。
结论
PD 治疗 PDAC 后，内侧手术切缘最为重要，R1 切除预示着预后不良。
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