Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Surg Oncol. 2015 Feb;41(2):220-7. doi: 10.1016/j.ejso.2014.11.041. Epub 2014 Dec 4.
Most survival studies comparing non-radical resections to bypass surgery in patients with pancreatic cancer often do not differentiate between an R1 and R2 resection. The aim of this study was to evaluate whether non-radical R1 and R2 resections have better postoperative outcomes and survival compared to a palliative bypass.
A single center cohort study was performed analyzing mortality, morbidity and 1-year survival after R1 (tumor cells within 1 mm from the circumferential margin), R2 and bypass surgery in patients with pancreatic cancer. For the systematic review, studies were identified comparing R1 or R2 resections with bypass, in patients with pancreatic cancer. Postoperative outcomes were compared including the cohort study.
The cohort study (n=405) showed higher morbidity rates after R1 (n=191) and R2 (n=11) resections compared to bypass (52% and 73% vs. 34%, p < 0.01). In-hospital mortality did not differ (overall 1.7%). 1-year survival rates were 71%, 46% and 32% after R1, R2 resection and bypass (p=0.6 between R2 and bypass). The systematic review identified 8 studies, after including the cohort study 1535 patients were analyzed. Increased morbidity after R1-R2 resection (48%) compared to bypass (30-34%) was found. Median survival was 14-18 months after R1 resection vs. 9-13 months after bypass and 8.5-11.5 months after R2 resection vs. 7.5-10.7 months after bypass.
An R2 resection should be avoided in patients with pancreatic cancer due to its poor prognosis. Survival benefit after an R1 resection, as compared to bypass surgery, justifies a resection despite the increased morbidity rate.
大多数比较胰腺癌非根治性切除术与旁路手术的生存研究通常没有区分 R1 和 R2 切除术。本研究旨在评估非根治性 R1 和 R2 切除术与姑息性旁路相比是否具有更好的术后结果和生存。
对单中心队列研究分析了 R1（肿瘤细胞距离环周切缘 1mm 以内）、R2 和旁路手术后胰腺癌患者的死亡率、发病率和 1 年生存率。对于系统评价，比较了 R1 或 R2 切除术与旁路手术治疗胰腺癌患者的研究。包括队列研究在内，比较了术后结果。
队列研究（n=405）显示 R1（n=191）和 R2（n=11）切除术的发病率高于旁路（52%和 73%比 34%，p<0.01）。住院死亡率无差异（总体 1.7%）。R1、R2 切除和旁路治疗后的 1 年生存率分别为 71%、46%和 32%（R2 和旁路之间无差异，p=0.6）。系统评价确定了 8 项研究，包括队列研究后共分析了 1535 例患者。发现 R1-R2 切除术（48%）的发病率高于旁路（30-34%）。R1 切除后中位生存时间为 14-18 个月，旁路为 9-13 个月，R2 切除后为 8.5-11.5 个月，旁路为 7.5-10.7 个月。
由于预后不良，R2 切除术应避免用于胰腺癌患者。与旁路手术相比，R1 切除术的生存获益证明了尽管发病率增加，但仍需要进行切除术。
