胰腺导管腺癌远端切除术切缘状态对预后的影响。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-04-04 DOI:10.1016/j.hpb.2025.04.001

Go-Won Choi , Won-Gun Yun , Mirang Lee, Hye-Sol Jung, Young J. Cho, Youngmin Han, Wooil Kwon, Jin-Young Jang

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引用次数: 0

摘要

背景：根治性切除是胰切除术中一个众所周知的预后因素。然而，远端胰腺切除术切缘的定义和临床意义仍存在争议。方法：选取2010 ~ 2018年行远端胰腺切除术的胰腺癌患者203例。患者分为r0 -宽（无肿瘤切缘≥1mm）和r0 -窄（0 mm）三组。结果：r0 -宽切缘患者（36.6%）的5年无病生存率优于r0 -窄切缘患者（30.4%,p = 0.059）或R1切缘患者（0.1%,p = 0.014）。然而，在多变量分析中，只有R1边际(风险比[95%置信区间]，2.02 [1.32-3.12]；p = 0.001)，不像r0 -窄边际(1.17 [0.78-1.77]；p = 0.446)，与r0宽边际相比，总生存期较短。在多变量分析中，后缘受累是唯一确定的不良预后因素(1.83 [1.07-3.13]；p = 0.027)。结论：0 mm规则比1 mm规则更适合预测远端胰腺切除术的预后，特别是显微镜下后缘阴性是至关重要的。

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Prognostic implications of resection margin status in distal pancreatectomy for pancreatic ductal adenocarcinoma

Background

Curative resection is a well known prognostic factor in pancreatectomy. However, definition and clinical significance of resection margin in distal pancreatectomy remains controversial.

Methods

From 2010 to 2018, 203 patients with pancreatic cancer undergoing distal pancreatectomies were included. Patients were classified into three groups: R0-wide (tumor-free margin ≥1 mm), R0-narrow (0 mm < tumor-free margin <1 mm), and R1 margin (tumor-free margin = 0 mm). We also evaluated the prognostic impact of individual margins (transection, anterior, and posterior).

Results

Patients with an R0-wide margin (36.6 %) exhibited superior 5-year disease free survival rate compared to those with R0-narrow (30.4 %, p = 0.059) or R1 margin (0.1 %, p = 0.014). However, in multivariate analyses, only R1 margin (hazard ratio [95 % confidence interval], 2.02 [1.32–3.12]; p = 0.001), unlike R0-narrow margin (1.17 [0.78–1.77]; p = 0.446), was linked to shorter overall survival compared to R0-wide margin. In multivariate analyses, posterior margin involvement was uniquely identified as a poor prognostic factor (1.83 [1.07–3.13]; p = 0.027).

Conclusions

The 0 mm rule seems more suitable than the 1 mm rule for predicting prognosis in performing distal pancreatectomy, and especially, achieving microscopically negative posterior margin is crucial.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).