Department of Pathology, Odense University Hospital, Odense, Denmark; Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Odense Patient Data Exploratory Network-OPEN, Odense University Hospital, Odense, Denmark.
Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Odense Patient Data Exploratory Network-OPEN, Odense University Hospital, Odense, Denmark; Department of Surgery, Odense University Hospital, Odense, Denmark.
HPB (Oxford). 2024 Feb;26(2):241-250. doi: 10.1016/j.hpb.2023.10.009. Epub 2023 Oct 12.
In this Danish nationwide population-based study, we evaluated the prognostically relevant minimum tumour-free margin width following pancreaticoduodenectomy (PD) for ampullary adenocarcinoma (AAC) and evaluated whether certain margins hold independent prognostic information.
We included 128 patients who underwent PD for AAC from 2015 to 2019. Clinical and pathological data including well-known prognostic factors were retrieved from the Danish Pancreatic Cancer Database. Missing data were obtained by review of pathology reports and re-microscopy of resection specimens. All PD specimens were examined using a standardised pathological protocol including multicolour inking, axial slicing and exact reporting of margin widths. The cohort was dichotomised into involved and uninvolved groups, using different margin clearance definitions (0.5-≥3.0 mm).
Following PD for AAC, margin clearance of ≥1 mm was independently associated with improved chance of survival compared with <1 mm (HR: 0.30, 95 % CI: 0.14-0.64 (p = 0.002)). Posterior and anterior margin widths were narrower compared with superior mesenteric artery and vein margins. Posterior margin and anterior surface had isolated prognostic significance in multivariable analysis.
Following PD for AAC, margin clearance of at least 1 mm is independently associated with improved survival. Our data further indicate that anterior surface and posterior margin hold particular prognostic value.
在这项丹麦全国范围内基于人群的研究中，我们评估了接受胰十二指肠切除术（PD）的壶腹腺癌（AAC）的预后相关最小无肿瘤切缘宽度，并评估了某些切缘是否具有独立的预后信息。
我们纳入了 2015 年至 2019 年期间因 AAC 接受 PD 的 128 例患者。临床和病理数据，包括众所周知的预后因素，均从丹麦胰腺癌数据库中获取。通过查阅病理报告和重新检查切除标本的显微镜检查来获取缺失的数据。所有 PD 标本均使用标准化的病理方案进行检查，包括多色标记、轴向切片和精确报告切缘宽度。该队列根据不同的切缘清除定义（0.5-≥3.0 mm）分为受累组和未受累组。
在接受 PD 治疗 AAC 后，与<1 mm 相比，切缘清除≥1 mm 与生存率提高独立相关（HR：0.30，95%CI：0.14-0.64（p=0.002））。与肠系膜上动脉和静脉边缘相比，后缘和前缘的切缘较窄。在后向和前向分析中，切缘宽度有独立的预后意义。
在接受 PD 治疗 AAC 后，至少 1 mm 的切缘清除与生存率提高独立相关。我们的数据进一步表明，前表面和后缘具有特殊的预后价值。
