Abstract
The R1 rate and prognostic significance of microscopic margin involvement differ consistently between published series. This divergence results from a lack of consensus regarding various aspects of margin status assessment. Central to the controversies is the lack of clarity about what ‘R1’ exactly stands for. The current UICC definition—residual microscopic tumor—is possibly too general and invites divergent interpretations. Adherence to different diagnostic criteria for microscopic margin involvement and divergent terminology for the various margins of pancreatoduodenectomy specimens add to the confusion. Furthermore, recent studies demonstrated that the dissection technique and extent of tissue sampling influence the accuracy of margin assessment. Axial specimen slicing, extensive tissue sampling, and multicolored margin inking result in a significantly higher, more accurate R1 rate than when using traditional grossing techniques. Only when international consensus on these various aspects is reached will pathology data on margin involvement be reliable and can multicenter clinical trials produce compelling evidence that allows improved pancreatic cancer treatment.
Zusammenfassung
Die R1-Rate und die prognostische Bedeutung der mikroskopischen Resektionsrandbeteiligung unterscheiden sich beständig zwischen veröffentlichten Fallserien. Dieser Unterschied resultiert aus einem fehlenden Konsens hinsichtlich verschiedener Aspekte der Beurteilung des Resektionsrandstatus. Zentral für die Meinungsverschiedenheiten ist die fehlende Klarheit darüber, wofür „R1“ genau steht. Die aktuelle UICC-Definition – mikroskopischer Residualtumor – ist möglicherweise zu allgemein und lädt zu verschiedenen Interpretationen ein. Die Beachtung verschiedener diagnostischer Kriterien für die mikroskopische Resektionsrandbeteiligung und unterschiedliche Terminologien für die verschiedenen Ränder der Pankreatikoduodenektomiepräparate tragen zu der Verwirrung bei. Darüber hinaus zeigten aktuelle Studien, dass die chirurgische Präparationstechnik und das Ausmaß der Gewebeprobenentnahme die Genauigkeit der Resektionsrandbeurteilung beeinflussen. Axiales Schneiden der Präparate, ausgedehnte Gewebeprobenentnahme und mehrfarbige Randfärbung führen zu einer signifikant höheren, genaueren R1-Rate als die Verwendung herkömmlicher Dissektionstechniken. Nur dann, wenn ein internationaler Konsens hinsichtlich der verschiedenen Aspekte erzielt wird, können pathologische Daten zur Resektionsrandbeteiligung reliabel werden und klinische Multizenterstudien zu überzeugender Evidenz gelangen, die eine bessere Behandlung bei Pankreaskarzinomen ermöglicht.
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Conflict of interest. C.S. Verbeke states that there are no conflicts of interest. The supplement this article is part of is not sponsored by the industry.
The accompanying manuscript does not include studies on humans or animals.
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Verbeke, C. Resection margins in pancreatic cancer. Pathologe 34 (Suppl 2), 241–247 (2013). https://doi.org/10.1007/s00292-013-1799-5
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DOI: https://doi.org/10.1007/s00292-013-1799-5