Redefining the R1 resection in pancreatic cancer
Redefining the R1 resection in pancreatic cancer
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DOI：
10.1002/bjs.5397
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发表时间：
2006-10-01
影响因子：
9.6
通讯作者：
Anthoney, A.
中科院分区：
文献类型：
--
作者：
Verbeke, C. S.;Leitch, D.;Anthoney, A.
背景：胰头腺癌的切缘(RM)状态是由组织学评估的，但病理检查并不规范。本研究的目的是评估标准化病理检查对报告RM状态的影响。方法：建立一套标准化的胰腺十二指肠切除标本检查方案(SP)，包括边缘多色染色、轴位切片和广泛的组织采样。Ri切除定义为Rm转角内的转移率。根据该方案报道的前瞻性系列(SP系列，n=54)与使用非标准化方案的历史匹配系列(NSP系列，n=48)进行比较。结果：实施SP总体上导致了较高的RI率，胰腺癌(22/26 85%)高于壶腹癌(4/15)和胆管癌(6/13)。在SP系列中，周向RM的采样范围更广，并与RM状态相关。RM受累通常是多灶性的(14/32)，最常累及后部RM(21/32)。存活率与整个SP系列(P<；0.001)的RM状态相关，但与NSP系列无关。在SP胰腺癌亚组中，R0切除后有较好的中位和精算5年生存率的趋势。结论：标准化检查影响了RM状态的报告。
Background: Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status.Methods: A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. RI resection was defined as turnout within I turn of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non-standardized protocol was used (NSP series, n = 48).Results: Implementation of the SP resulted in a higher RI rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0.001), but not for the NSP series. There was a trend towards better median and actuarial 5-year survival after R0 resection in the SP pancreatic cancer subgroup.Conclusion: Standardized examination influences the reporting of RM status.