Weber G F, Kersting S, Haller F, Grützmann R
Chirurgische Klinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland.
Chirurg. 2017 Sep;88(9):764-770. doi: 10.1007/s00104-017-0462-8.
Surgery is the only potentially curative therapeutic approach in patients with pancreatic ductal adenocarcinoma (PDAC); however, achieving a negative (R0) resection margin is not always possible.
The impact of R1 resection margins on survival rates and treatment options (surgical and multimodal) for intraoperatively and postoperatively identified R1 resection margins.
For intraoperatively diagnosed R1 resection margins, a re-resection (e.g. pancreas, main bile duct, stomach, superior mesenteric and portal vein) can be performed to achieve R0 resection margins. Arterial resections and the resection of additional organs are occasionally technically feasible and can be performed in an individual approach. New neoadjuvant and adjuvant treatment strategies have increased the rate of resectable PDAC and have improved the outcome of patients with R0/R1 resected PDACs.
An R0 resection is the primary goal of surgery in patients with PDAC as R1 resections are correlated with a poor outcome.
手术是胰腺导管腺癌（PDAC）患者唯一可能治愈的治疗方法；然而，实现阴性（R0）切缘并不总是可行的。
R1切缘对术中及术后确定为R1切缘患者的生存率和治疗选择（手术和多模式治疗）的影响。
对于术中诊断为R1切缘的情况，可进行再次切除（如胰腺、肝总管、胃、肠系膜上静脉和门静脉）以实现R0切缘。动脉切除和额外器官的切除偶尔在技术上是可行的，并且可以个体化进行。新的新辅助和辅助治疗策略提高了可切除PDAC的比例，并改善了R0/R1切除的PDAC患者的预后。
R0切除是PDAC患者手术的主要目标，因为R1切除与不良预后相关。
