gms | German Medical Science

133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

Artikel

Artikel empfehlen

Pancreatic Cancer Surgery: The New R-status Counts

Meeting Abstract

Suche in Medline nach

  • Oliver Strobel - Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Thomas Hank - Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Ulf Hinz - Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Frank Bergmann - Institit für Pathologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Christoph Springfeld - NCT Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Dirk Jäger - NCT Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Peter Schirmacher - Universitätsklinikum Heidelberg, Institut für Pathologie, Heidelberg, Deutschland
  • Thilo Hackert - Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Markus Wolfgang Büchler - Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch519

doi: 10.3205/16dgch519, urn:nbn:de:0183-16dgch5194

Veröffentlicht: 21. April 2016

© 2016 Strobel et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Background: The definitions for R0 and R1 margin status after resection for pancreatic cancer are controversial and reported R0/R1 rates and associated survival are highly heterogeneous. A strict definition of R1 (margin clearance of ≤1mm) is accepted in Europe, but not internationally. A prospective validation of this definition based on associated survival is missing. The impact of margin status on survival in the context of adjuvant therapy remains unclear.

Methods: A standardized protocol with evaluation of circumferential margins and the novel R1 definition were introduced into clinical routine in 2005. From a prospective database, patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma between 01/2006 and 12/2012 were identified. The rate of R0, R1 (≤1mm clearance) and R1 (direct margin involvement) status and associated survival were assessed by uni- and multivariable analyses.

Results: Of 561 patients with pancreatic adenocarcinoma, 112 (20.0%) had R0, and 449 (80.0%) had R1 resections, including 123 (21.9%) R1 (≤1mm) and 326 (58.1%) R1 (direct) resections. 438 (85.9%) patients received adjuvant chemotherapy. Margin status was significantly associated with survival. With R0, R1 (≤1mm) and R1 (direct) status the median survival times and five-year survival rates were 41.6, 27.5 and 23.4 months; and 37.7, 30.1 and 20.3%, respectively (p<0.0001). By multivariable analysis, margin status was confirmed to be independently associated with survival.

Conclusion: In the era of adjuvant chemotherapy the resection margin status remains an important independent determinant of post-resection survival. R0/R1 resection rates and associated survival vary significantly with the definitions used. An international consensus is urgently needed to achieve comparability with respect to studies and protocols on adjuvant therapy.