Aiming for high quality of care for completed resections and improved margin status in pancreatic cancer surgery.

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-10-06 DOI:10.1016/j.pan.2025.09.029

Ashika D Maharaj, Bronwyn Brown, Hamish Evans, Sue M Evans, Liane J Ioannou, Arul Earnest, Daniel Croagh, Charles Hc Pilgrim, Elysia Greenhill, Rachel E Neale, David Goldstein, James G Kench, Neil D Merrett, Kate White, Koroush S Haghighi, Jaswinder S Samra, John R Zalcberg

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引用次数: 0

Abstract

Purpose: To assess associations between six diagnostic, staging, and coordination of care indicators in pancreatic cancer, and: (1) surgery being abandoned intraoperatively; or (2) a positive macroscopic margin (R2 resection) or a positive microscopic pathological margin (R1 resection).

Methods: Data was provided by the Upper Gastrointestinal Cancer Registry operating across two Australian states. Associations were tested using multivariable logistic regression.

Results: 704 patients underwent an attempted surgical resection (54 % male; median age 69 years). Of the completed resections (n = 585) with a known margin status (n = 513), 54 % (n = 278) were reported as having a negative pathological (R0) margin, 41 % (n = 211) had an R1 margin, and 5 % (n = 24) had an R2 margin. Patients who underwent surgery or neoadjuvant therapy within 60 days from referral had double the odds of a complete resection (OR=2.12, 95 % CI, 1.19 - 3.76). Imaging undertaken beyond 30 days prior to surgery had a 40 % reduction in the odds of a completed resection (OR=0.58, 95 % CI, 0.37 - 0.92). Patients with their ECOG and/or ASA documented at presentation had 90 % increased odds of a R0 margin resection (OR=1.90, 95 % CI, 1.32 - 2.73).

Conclusions: Timely progression to primary treatment had the most significant association with achieving complete resection status.

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旨在提高胰腺癌手术中完整切除的护理质量和改善切缘状况。

目的：评估胰腺癌六项诊断、分期和协调护理指标与：(1)术中放弃手术之间的关系；或(2)宏观边缘阳性（R2切除）或微观病理边缘阳性（R1切除）。方法：数据由澳大利亚两个州的上消化道癌症登记处提供。使用多变量逻辑回归检验相关性。结果：704例患者尝试手术切除（54%为男性，中位年龄69岁）。在已知切缘状态（n = 513）的完整切除（n = 585）中，54% （n = 278）报告为阴性病理（R0）切缘，41% （n = 211）为R1切缘，5% （n = 24）为R2切缘。转诊后60天内接受手术或新辅助治疗的患者完全切除的几率增加一倍（or =2.12, 95% CI, 1.19 - 3.76）。手术前30天以上进行影像学检查可使完全切除的几率降低40% （OR=0.58, 95% CI, 0.37 - 0.92）。就诊时有ECOG和/或ASA记录的患者R0切缘切除的几率增加90% （or =1.90, 95% CI, 1.32 - 2.73）。结论：及时进展到初级治疗与达到完全切除状态有最显著的关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.