Takahashi Daigoro, Kojima Motohiro, Sugimoto Motokazu, Kobayashi Shin, Takahashi Shinichiro, Konishi Masaru, Gotohda Naoto, Nagino Masato
Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya.
Pancreas. 2018 Aug;47(7):830-836. doi: 10.1097/MPA.0000000000001106.
Processing of pancreatoduodenectomy specimens is not standardized; the clinical impact of pathologic surgical margins remains controversial. We used the color-coding method using tissue-marking dyes to evaluate margin status of resected specimens to assess its association with postoperative recurrence.
We developed a unified processing approach to assess pancreatoduodenectomy specimens. Five surgical margins of resected pancreatic specimens were marked with 5 colors. Microscopic resection margin distance (RMD) from margin closest to the tumor was evaluated for each surgical margin. Forty patients assessed using nonunified protocols, and 98 patients assessed using unified protocols were included.
The frequency of tumors with RMD of 1 mm or less in posterior margin was significantly lower and that in portal vein/superior mesenteric vein margin was significantly higher in unified protocol group than in nonunified protocol group (P < 0.001). In unified protocol group, tumors with RMD of 1 mm or less correlated with locoregional recurrence (P = 0.025) and recurrence-free survival (P = 0.030). Multivariate analysis revealed that tumor size and lymph node metastasis were independent indicators for disease recurrence.
Resection margin distance of 1 mm or less was a predictor for disease recurrence, particularly for locoregional recurrence. Early detection of small-sized tumors without lymph node metastasis is necessary for improved clinical outcomes in pancreas cancers.
胰十二指肠切除术标本的处理不规范；手术切缘病理的临床影响仍存在争议。我们采用组织标记染料的颜色编码方法评估切除标本的切缘状态，以评估其与术后复发的相关性。
我们开发了一种统一的处理方法来评估胰十二指肠切除术标本。用5种颜色标记切除胰腺标本的5个手术切缘。评估每个手术切缘距最接近肿瘤的切缘的显微镜下切除边缘距离（RMD）。纳入40例采用非统一方案评估的患者和98例采用统一方案评估的患者。
统一方案组后缘RMD为1mm或更小的肿瘤频率显著低于非统一方案组，门静脉/肠系膜上静脉切缘的肿瘤频率显著高于非统一方案组（P<0.001）。在统一方案组中，RMD为1mm或更小的肿瘤与局部区域复发（P=0.025）和无复发生存率（P=0.030）相关。多因素分析显示肿瘤大小和淋巴结转移是疾病复发的独立指标。
1mm或更小的切除边缘距离是疾病复发的预测指标，特别是对于局部区域复发。早期发现无淋巴结转移的小肿瘤对于改善胰腺癌的临床结局是必要的。
