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Revision of Surgical Margin under Frozen Section to Achieve R0 Status on Survival in Patients with Pancreatic Cancer

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Objective

The aim is to investigate whether additional resection based on intraoperative frozen section (FS) to a secondary R0(s) status are associated with different long-term survivals in pancreatic cancer patients, comparing to those with R1 or primary R0(p) status.

Methods

A systematic literature search (PubMed, Embase, Science Citation Index, Springer-Link, and Cochrane Central Register of Controlled Trials) was performed to identify all studies published up to June 2017. Survivals of patients undergoing pancreatic surgery according to the results of FS and re-resection were pooled for analysis.

Results

Five cohort studies were qualified for inclusion in this review with a total of 2980 patients. Long-term survival outcomes favored R0(p) resection as compared to R0(s) resection (HR = 1.58, 95%CI 1.24–2.01, P = 0.0002, I2 = 58%). No significant difference was observed for patients with or without additional resection at the time of surgery when positive FS was detected (HR = 0.98, 95CI% 0.65–1.47, P = 0.91, I2 = 81%).

Conclusions

The present study did not support the concept of achieving an R0 resection by intraoperative re-resection would benefit the patient’s survival. R1 margin at the time of surgery is more like a marker of aggressive tumor biology. Future well-designed randomized controlled trials are needed to confirm the conclusion.

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Funding

Zi Yin received foundations from 2017 Guangdong Medical Science and Technology Fund (A2017102) and 2017 Guangdong Natural Science Fund (2017A030313905). Baohua Hou received foundations from 2016 National Science Fund (81672475). Zhixiang Jian received foundation from 2014 People’s livelihood science and technology project, Special Project on the Integration of Industry, Education and Research of Guangzhou City (2014Y200509).

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Author notes

  1. Zi Yin, Yu Zhou and Baohua Hou contributed equally to this work.

Authors and Affiliations

  1. General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China

    Zi Yin, Yu Zhou, Baohua Hou, Min Yu, Chuanzhao Zhang, Xin Lu & Zhixiang Jian

  2. Gynaecology and Obstetrics Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Tingting Ma

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  1. Zi Yin
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  2. Yu Zhou
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  4. Tingting Ma
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  5. Min Yu
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  6. Chuanzhao Zhang
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  7. Xin Lu
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Contributions

Z Yin, BH Hou, Y Zhou: data collection and elaboration, statistical analysis, writing of the manuscript.

TT Ma, X Lu, CZ Zhang, M Yu: data collection and elaboration.

Z Yin, ZX Jian: supervision.

Corresponding authors

Correspondence to Zi Yin or Zhixiang Jian.

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The authors declare that they have no conflicts of interest.

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Yin, Z., Zhou, Y., Hou, B. et al. Revision of Surgical Margin under Frozen Section to Achieve R0 Status on Survival in Patients with Pancreatic Cancer. J Gastrointest Surg 22, 1565–1575 (2018). https://doi.org/10.1007/s11605-018-3806-x

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  • DOI: https://doi.org/10.1007/s11605-018-3806-x

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