The influencing role of resection margin (R) status on long-term outcomes, namely overall (OS) and disease-free survival (DFS), after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is not still clear. The aim of this study is to evaluate the prognostic impact of R status after PD and to define tumor characteristics associated with a positive resection margin (R1). All PDs for PDAC performed between 2012 and 2023 were retrospectively enrolled. The effect of R status, patient clinico-demographic features, and tumor features on OS and DFS were assessed. One-hundred and sixty-seven patients who underwent PD for PDAC were included in the study. R0 was achieved in 105 cases (62.8%), while R1 was evidenced in 62 patients (37.1%). R1 was associated with a decreased OS (23 (13–38) months) as compared to R0 (36 (21–53) months) (p= 0.003). Similarly, DFS was shorter in R1 patients (10 (6–25) months) as compared to the R0 cohort (18 (9–70) months) (p= 0.004), with a consequent higher recurrence rate in cases of R1 (74.2% vs. 64.8% in the R0 group;p= 0.04). In the multivariate analysis, R1 and positive lymph nodes (N+) were the only independent influencing factors for OS (OR: 1.6; 95% CI: 1–2.5;p= 0.03 and OR: 1.7; 95% CI: 1–2.8;p= 0.04) and DFS (OR: 1.5; 95% CI: 1–2.1;p= 0.04 and OR: 1.8; 95% CI: 1.1–2.7;p= 0.009). Among 111 patients with N+ disease, R1 was associated with a significantly decreased DFS (10 (8–11) months) as compared to R0N+ patients (16 (11–21) months) (p= 0.05). In conclusion, the achievement of a negative resection margin is associated with survival benefits, particularly in cases of N1 disease. In addition, R0 was recognized as an independent prognostic feature for both OS and DFS. This further outlines the relevant role of radical surgery on long-term outcomes.
胰腺导管腺癌（PDAC）行胰十二指肠切除术（PD）后，切除边缘（R）状态对长期结局，即总生存期（OS）和无病生存期（DFS）的影响作用尚不明确。本研究旨在评估PD术后R状态的预后影响，并明确与阳性切除边缘（R1）相关的肿瘤特征。回顾性纳入2012年至2023年间进行的所有PDAC PD病例。评估了R状态、患者临床人口学特征及肿瘤特征对OS和DFS的影响。研究共纳入167例因PDAC接受PD的患者。其中105例（62.8%）达到R0切除，62例（37.1%）为R1切除。与R0患者（36（21–53）个月）相比，R1患者的OS降低（23（13–38）个月）（p=0.003）。同样，R1患者的DFS（10（6–25）个月）较R0组（18（9–70）个月）更短（p=0.004），因此R1病例的复发率更高（74.2% vs. R0组的64.8%；p=0.04）。在多变量分析中，R1和阳性淋巴结（N+）是OS（OR：1.6；95% CI：1–2.5；p=0.03和OR：1.7；95% CI：1–2.8；p=0.04）及DFS（OR：1.5；95% CI：1–2.1；p=0.04和OR：1.8；95% CI：1.1–2.7；p=0.009）的唯一独立影响因素。在111例N+疾病患者中，与R0N+患者（16（11–21）个月）相比，R1患者的DFS显著降低（10（8–11）个月）（p=0.05）。总之，实现阴性切除边缘与生存获益相关，尤其在N1疾病病例中。此外，R0被确认为OS和DFS的独立预后特征。这进一步强调了根治性手术对长期结局的重要作用。
肿瘤(癌症)患者之家