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Bedeutung der R1-Resektion im hepatobiliär-pankreatischen System

The effect of R1 resection in the hepatobiliary pancreatic system

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Zusammenfassung

Die komplette Tumorentfernung, d. h. die R0-Resektion, ist auch im hepatobiliär-pankreatischen System ein Grundprinzip der onkologischen Chirurgie. Die berichteten R1-Raten für bestimmte Tumorentitäten zeigen eine zum Teil große Variabilität, was auf Unklarheiten in Bezug auf die exakte Definition einer R1-Resektion sowie auf die häufig fehlende Standardisierung der histopathologischen Untersuchung beruht. R1-Resektionen können als technisch-chirurgisches Versagen interpretiert werden (z. B. bei kleinen peripheren Lebertumoren), sind aber wahrscheinlich in den meisten Fällen durch die anatomische Tumorlokalisation und das biologische Wachstumsverhalten (z. B. Pankreaskarzinom mit perineuraler Invasion) begründet. Eine R0-Resektion ist für viele Tumoren des hepatobiliär-pankreatischen Systems als positiver prognostischer Faktor identifiziert worden (im Vergleich zur R1-Resektion) und muss daher immer angestrebt werden. Gleichwohl bietet eine R1-Resektion bei den meisten Tumoren des hepatobiliär-pankreatischen Systems einen Vorteil im Hinblick auf Überleben und Lebensqualität im Vergleich zu keiner Resektion.

Abstract

Macroscopic and microscopic complete resection, i.e. R0 resection, is a basic principle of oncologic hepatopancreatobiliary (HPB) surgery. The reported R1 rates for different HPB tumor entities vary considerably, most likely because of ambiguities in the exact definition of R1 resection and the lack of standardized histopathologic examination and reporting. R1 resections can be interpreted as technical/surgical failure (e.g. for small, peripherally located liver tumors). In most cases, however, R1 resections are determined by the anatomic location of the tumor and the growth pattern (e.g. pancreatic cancer with perineural invasion). R0 resections have been identified as positive predictive markers for several HPB tumors (in comparison to R1 resection). Therefore HPB surgeons should always aim at macroscopic and microscopic complete resections. Nonetheless, R1 resections often provide an advantage over no resection with respect to survival and quality of life in patients with these tumors.

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  1. Chirurgische Klinik, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    A. Kolb, J. Kleeff, H. Friess &  M.W. Büchler

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  1. A. Kolb
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  2. J. Kleeff
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Correspondence to M.W. Büchler.

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Kolb, A., Kleeff, J., Friess, H. et al. Bedeutung der R1-Resektion im hepatobiliär-pankreatischen System. Chirurg 78, 802–809 (2007). https://doi.org/10.1007/s00104-007-1377-6

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