Leonhardt Carl-Stephan, Hinz Ulf, Kaiser Jörg, Hank Thomas, Tjaden Christine, Bergmann Frank, Hackert Thilo, Büchler Markus W, Strobel Oliver
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Eur J Surg Oncol. 2023 Jan;49(1):113-121. doi: 10.1016/j.ejso.2022.08.003. Epub 2022 Aug 9.
Resection margin status is a well-established prognosticator in pancreatic cancer. The prognostic impact of IPMN dysplasia at the pancreatic transection margin in IPMN-associated carcinoma (IPMN-Ca) remains unclear, hence institutional practices on additional resections vary.
Patients undergoing partial pancreatectomy or attempted partial pancreatectomy converted to total pancreatectomy for IPMN-Ca between 04/2002 and 12/2018 were identified. Final pathology of the definitive pancreatic transection margin was identified. The association between the presence of IPMN dysplasia at the margin and overall survival (OS) was assessed.
Of 302 patients with IPMN-Ca, 181 (59.9%) patients received partial pancreatoduodenectomy, 61 (20.2%) distal pancreatectomy, and 60 (19.9%) were converted to total pancreatectomy. Median OS was 98.6 months in R0 (≥1 mm), 39.3 months in R1 (<1 mm), and 22.0 months in R1(direct) resected patients, respectively (p < 0.0001). No IPMN dysplasia at the definitive margin was present in 103 (34.1%), low-grade in 131 (43.4%), and high-grade/R1 in 8 (2.6%) patients. Low-grade dysplasia or total pancreatectomy were not associated with shorter OS compared to dysplasia-free margin across the entire cohort. Sensitivity analyses confirmed a lack of prognostic relevance of low-grade IPMN dysplasia at the pancreatic margin in R0 resected IPMN-Ca and in R0 resected UICC stage IA/IB IPMN-Ca.
Low-grade IPMN at the transection margin is not associated with shorter overall survival after partial pancreatectomy for IPMN-Ca. Additional resections for low-grade dysplasia, up to total pancreatectomy do not result in a survival benefit and should be omitted. Due to limited sample size, high-grade dysplasia could not be analyzed.
切缘状态是胰腺癌中公认的预后指标。在胰腺导管内乳头状黏液性肿瘤相关癌（IPMN-Ca）中，胰腺切缘处IPMN发育异常的预后影响尚不清楚，因此关于额外切除的机构做法各不相同。
确定2002年4月至2018年12月期间因IPMN-Ca接受部分胰腺切除术或尝试部分胰腺切除术但转为全胰腺切除术的患者。确定最终胰腺切缘的最终病理。评估切缘处IPMN发育异常的存在与总生存期（OS）之间的关联。
在302例IPMN-Ca患者中，181例（59.9%）接受了胰十二指肠切除术，61例（20.2%）接受了远端胰腺切除术，60例（19.9%）转为全胰腺切除术。R0（≥1mm）切除患者的中位OS为98.6个月，R1（<1mm）切除患者为39.3个月，R1（直接）切除患者为22.0个月（p<0.0001）。103例（34.1%）患者的最终切缘无IPMN发育异常，131例（43.4%）为低级别，8例（2.6%）为高级别/R1。与整个队列中无发育异常的切缘相比，低级别发育异常或全胰腺切除术与较短的OS无关。敏感性分析证实，在R0切除的IPMN-Ca和R0切除的国际抗癌联盟（UICC）IA/IB期IPMN-Ca中，胰腺切缘处低级别IPMN发育异常缺乏预后相关性。
对于IPMN-Ca行部分胰腺切除术后，切缘处低级别IPMN与较短的总生存期无关。对低级别发育异常进行额外切除直至全胰腺切除术不会带来生存益处，应予以省略。由于样本量有限，无法分析高级别发育异常。
