Survival After Pancreaticoduodenectomy is not Improved by Extending Resections to Achieve Negative Margins
Survival After Pancreaticoduodenectomy is not Improved by Extending Resections to Achieve Negative Margins
复制标题
DOI：
10.1097/sla.0b013e3181ad655e
复制
发表时间：
2009-07-01
影响因子：
9
通讯作者：
Rosemurgy, Alexander
中科院分区：
文献类型：
--
作者：
Hernandez, Jonathan;Mullinax, John;Rosemurgy, Alexander
目的：这项研究旨在确定扩大切除范围以获得术中阳性冰冻切片后显微镜下阴性切缘的生存益处。摘要背景数据：胰腺十二指肠切除术后残留的显微镜疾病的影响目前是一个争议点。然而，人们普遍认为，显微镜下的正切缘对生存率有负面影响，最终获得负切缘可能会改善这种情况。方法：自1995年以来，对胰腺癌患者进行了前瞻性跟踪观察。边际状态已编码为宏观/微观为负(R0)或宏观为负/微观为正(R1)。生存曲线分析评估切缘状态对生存的影响。数据以中位数、平均+/-SD表示。结果：对于胰腺癌，202例患者接受了胰腺十二指肠切除术。在158名患者中完成了R0切除，其中17人在术中冰冻切片(R1->；R0)初步阳性后需要扩大切除以实现肿瘤完全切除。44例患者接受了R1切除。接受R0切除的患者的中位生存期为21个月，26+/-23.4个月，而接受RI切除的患者的中位生存期为13个月，17+/-21.0个月(P=0.02)。接受R1-和R0切除的患者的中位生存期为11个月，16+/-17.3，(P=0.001)。切缘状态与“N”期和AJCC分期显著相关，而与“T”期无关。结论：术中冰冻切片初步阳性后，扩大胰腺切除范围以获得负切缘并不能提高胰腺十二指肠切除术后的存活率。在接受RI切除的患者中，除了手术切缘存在疾病外，肿瘤特有的因素也是导致生存期缩短的原因。
Objective: This study was undertaken to determine the survival benefit of extending resections to obtain microscopically negative margins after positive intraoperative frozen sections.Summary Background Data: The impact of residual microscopic disease after pancreaticoduodenectomy is currently a point of controversy. It is, however, generally believed that microscopically positive margins negatively impact survival and this may be improved by ultimately achieving negative margins.Methods: Since 1995, patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma have been prospectively followed. Margin status has been codified as macro/microscopically negative (R0) or macroscopically negative/microscopically positive (R1). The impact of margin status on survival was evaluated utilizing Survival curve analysis. Data are presented as median, mean +/- SD where appropriate.Results: For pancreatic adenocarcinoma, 202 patients underwent pancreaticoduodenectomy. R0 resections were achieved in 158 patients, 17 of whom required extended resections to achieve complete tumor extirpation after an initially positive intraoperative frozen section (R1 -> R0). R1 resections were undertaken in 44 patients. Median survival for patients undergoing R0 resections was 21 months, 26 +/- 23.4 months versus 13 months, 17 +/- 21.0 months for patients undergoing RI resections (P = 0.02). Median survival for patients undergoing R1 -> R0 resections was 11 months, 16 +/- 17.3, (P = 0.001). Margin status had a significant correlation with "N" stage and AJCC stage but not "T" stage.Conclusion: Survival after pancreaticoduodenectomy is not improved by extending pancreatic resections to achieve negative margins after initially positive intraoperative frozen sections. Tumor-specific factors beyond the presence of disease at a surgical margin are responsible for the abbreviated survival seen in patients undergoing RI resections.