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Recenzirano
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Crippa, Stefano; Giannone, Fabio; Schiavo Lena, Marco; Belfiori, Giulio; Partelli, Stefano; Tamburrino, Domenico; Delpini, Roberto; Pagnanelli, Michele; Pecorelli, Nicolo; Balzano, Gianpaolo; Doglioni, Claudio; Falconi, Massimo
Annals of surgical oncology, 08/2021, Letnik: 28, Številka: 8Journal Article
Background The prognostic role of resection margins in pancreatic ductal adenocarcinoma (PDAC) is debated. This study aimed to investigate the impact that global and individual resection margin status after pancreatic head resection for PDAC has on disease-free survival (DFS) and disease-specific survival (DSS). Methods Surgical specimens of pancreaticoduodenectomy/total pancreatectomy performed for PDAC were examined with a standardized protocol. Surgical margin status (biliary, pancreatic neck, duodenal, anterior and posterior pancreatic, superior mesenteric vein groove and superior mesenteric artery margins) was classified as the presence of malignant cells (1) directly at the inked surface ( R 1 direct), (2) within less than 1 mm ( R 1 ≤ 1 mm), or (3) with a distance greater than 1 mm ( R 0). Patients with a positive neck margin at the final histology were excluded from the study. Results Of the 362 patients included in the study, 179 patients (49.4 %) had an R 0 resection, 123 patients (34 %) had an R 1 ≤ 1 mm resection, and 60 patients (16.6 %) had an R 1 direct resection. The independent predictors of DFS were R 1 direct resection (hazard ratio HR, 1.49), R 1 ≤ 1 mm resection (HR, 1.38), involvement of one margin (HR, 1.36), and involvement of two margins or more (HR, 1.55). When surgical margins were analyzed separately, only R 1 ≤ 1 mm superior mesenteric vein margin (HR, 1.58) and R 1 direct posterior margin (HR, 1.69) were independently associated with DFS. Conclusions Positive R status is an independent predictor of DFS ( R 1 direct and R 1 ≤ 1 mm definitions) and of DSS ( R 1 direct). The presence of multiple positive margins is a risk factor for cancer recurrence and poor survival. Different surgical margins could have different prognostic roles.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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Vir: Osebne bibliografije
in: SICRIS
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