肝周胆管癌放射状边缘状态的相关性:最新叙述性综述。

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2024-03-06 DOI:10.1159/000535995
Mario De Bellis, Maria Gaia Mastrosimini, Paola Capelli, Laura Alaimo, Simone Conci, Tommaso Campagnaro, Sara Pecori, Aldo Scarpa, Alfredo Guglielmi, Andrea Ruzzenente
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引用次数: 0

摘要

背景:肝周胆管癌(PHCC)的预后很差,而治愈性切除是与长期生存相关的最有效治疗方法。手术对技术要求很高,因为需要进行肝大部切除,并对尾状叶和肝外胆管进行全切。此外,为了达到阴性边缘,可能需要同时进行血管切除术或胰十二指肠切除术。小结:文献报道,边缘阴性的患者生存率更高,而令人惊讶的 R0 切除率介于 19% 与 95% 之间。这种差异可能是由于不同的手术策略和病理学家对标本的专业知识造成的。事实上,对残留疾病进行适当的病理检查应同时考虑导管和径向边缘(RM)的状态。目前,缺乏详细的病理报告,而且由于缺少RM描述和使用不同的手术切缘定义,可能会对残留疾病状况产生误解:关键信息:PHCC手术的目的是实现包括RM在内的阴性边缘。需要更清晰地报告RM,以定义真正的根治性切除,并为辅助治疗设计一致的肿瘤学研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Relevance of Radial Margin Status in Perihilar Cholangiocarcinoma: A State-of-the-Art Narrative Review.

Background: Prognosis of perihilar cholangiocarcinoma (PHCC) is poor, and curative-intent resection is the most effective treatment associated with long-term survival. Surgery is technically demanding since it involves a major hepatectomy with en bloc resection of the caudate lobe and extrahepatic bile duct. Furthermore, to achieve negative margins, it may be necessary to perform concomitant vascular resection or pancreatoduodenectomy. Despite this aggressive approach, recurrence is often observed, considering 5-year recurrence-free survival below 15% and 5-year overall survival that barely exceeds 40%.

Summary: The literature reports that survival rates are better in patients with negative margins, and surprisingly, R0 resections range between 19% and 95%. This variability is probably due to different surgical strategies and the pathologist's expertise with specimens. In fact, a proper pathological examination of residual disease should take into consideration both the ductal and the radial margin (RM) status. Currently, detailed pathological reports are lacking, and there is a likelihood of misinterpreting residual disease status due to the missing of RM description and the utilization of various definitions for surgical margins.

Key messages: The aim of PHCC surgery is to achieve negative margins including RM. More clarity in reporting on RM is needed to define true radical resection and consistent design of oncological studies for adjuvant treatments.

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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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