Abstract:
OBJECTIVE:To assess the relevance of resection margin status for survival outcome after resection and adjuvant therapy for pancreatic cancer. BACKGROUND:The definitions for R0 and R1 margin status after resection for pancreatic cancer are controversial. The strict definition of R0 requiring a 1 mm tumor-free margin is not commonly accepted. Reported R0/R1 rates and associated survival are highly heterogeneous. METHODS:A standardized protocol with rigorous assessment of circumferential margins and the R0 definition with a 1 mm free margin were introduced into clinical routine in 2005. From a prospective database, patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma between January 1, 2006 and December 12, 2012 were identified. The rates of R0 (≥1 mm margin), R1 (<1 mm clearance), and R1 (direct margin involvement) status and associated survival were assessed by uni- and multivariable analyses. RESULTS:Of 561 patients included, 112 patients (20.0%) had R0 and 449 patients (80.0%) had R1 resections, including 123 (21.9%) R1 (≤1 mm) and 326 (58.1%) R1 (direct) resections. A total of 438 (85.9%) received adjuvant therapy. With R0, R1 (<1 mm), and R1 (direct) status the median survival times and 5-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. CONCLUSIONS:In the context of adjuvant therapy, the resection margin status remains an important independent determinant of postresection 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 patients with adjuvant therapy.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Strobel O,Hank T,Hinz U,Bergmann F,Schneider L,Springfeld C,Jäger D,Schirmacher P,Hackert T,Büchler MWdoi
10.1097/SLA.0000000000001731subject
Has Abstractpub_date
2017-03-01 00:00:00pages
565-573issue
3eissn
0003-4932issn
1528-1140journal_volume
265pub_type
杂志文章abstract:OBJECTIVE:To compare resection rates and outcome of patients subsequently referred with hepatic metastases whose initial colon cancers were resected by surgeons with different specialty interests. SUMMARY BACKGROUND DATA:Variation in practice among noncolorectal specialist surgeons has led to recommendations that colo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199912000-00004
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:To study the mechanical characteristics of the esophagogastric junction (EGJ) of postfundoplication patients and compare them with previously reported data on normal subjects and GERD patients. METHODS:Eight normal subjects, 9 GERD patients, and 8 fundoplication patients were studied with concurrent manometr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000167868.44211.f0
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to report 10+ year outcome of laparoscopic biliopancreatic diversion with duodenal switch (LDS), with special focus on quality of life. BACKGROUND::Reports on long-term morbidity and quality of life after LDS are rare. METHODS:Records of all patients who underwent LDS 10+ years ago ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001622
更新日期:2016-12-01 00:00:00
abstract::This study determines the infiltration rate of proximal and distal margins of resection in patients operated on for gastric cancer at the Istituto Nazionale Tumori of Milan. Two hundred and eighty-five proximal margins and 286 distal margins were reviewed, and the incidence of infiltration was related to the length of...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198212001-00012
更新日期:1982-12-01 00:00:00
abstract::We have demonstrated previously that oxygen-derived free radicals are important mediators of tissue injury following ischemia (total venous occlusion) and reperfusion in small (3 cm X 6 cm) island skin flaps in rats. In this study, we evaluated extension of this concept to regional ischemia in large (8 cm X 8 cm) acut...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198503000-00018
更新日期:1985-03-01 00:00:00
abstract::Adipocyte lipolysis and its adrenergic control were studied in vitro from normal patients and those with trauma and sepsis. The adrenergic receptors were studied in terms of their responsiveness, a measure of the postreceptor mechanism, and their sensitivity, a measure of the receptor number or affinity. With early tr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198712000-00010
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:To determine whether the acute anti-inflammatory influence of epinephrine (EPI) extends to changes in heart rate variability (HRV) induced by the prototypical inflammatory stimulus, endotoxin (lipopolysaccharide [LPS]). SUMMARY BACKGROUND DATA:HRV reflects fluctuating cardiac autonomic inputs and is acutely ...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181a40193
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:Arginine transport was characterized and studied in human liver. SUMMARY BACKGROUND DATA:Plasma arginine uptake may regulate hepatocyte intracellular availability and the subsequent biosynthesis of nitric oxide (NO), but little is known about arginine transport across the human hepatocyte plasma membrane. M...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199309000-00014
更新日期:1993-09-01 00:00:00
abstract:OBJECTIVE:To perform a systematic review and meta-analysis of studies comparing operative to nonoperative therapy in adult FC patients. Outcomes were duration of mechanical ventilation (DMV), intensive care unit length of stay (ICULOS), hospital length of stay (HLOS), mortality, incidence of pneumonia, and tracheostomy...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1097/SLA.0b013e3182895bb0
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:To determine whether F-fluorodeoxyglucose (F-FDG) micro-positron emission tomography (micro-PET) can predict abdominal aortic aneurysm (AAA) rupture. BACKGROUND:An infrarenal AAA model is needed to study inflammatory mechanisms that drive rupture. F-FDG PET can detect vascular inflammation in animal models a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000602
更新日期:2015-02-01 00:00:00
abstract::Over a 24-year period, 411 partial hepatic resections were performed: 142 right or left trisegmentectomies, 158 lobectomies, 25 segmentectomies, and 86 local excisions. The operations were performed for benign lesions in 182 patients, for primary hepatic malignancies in 106, and for hepatic metastases in 123, includin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198810000-00004
更新日期:1988-10-01 00:00:00
abstract:OBJECTIVES:We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. METHODS:Peripheral blood was withdrawn from 19 consenting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000239031.06906.1f
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:The role for neoadjuvant systemic therapy in resectable pancreas adenocarcinoma remains undefined. OBJECTIVE:We evaluated the efficacy of gemcitabine and oxaliplatin administered as preoperative therapy in patients with resectable pancreas adenocarcinoma. METHODS:Eligible patients were screened using compu...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000000251
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:This study investigated the pathogenesis of water and sodium metabolism derangements in obstructive jaundice. SUMMARY BACKGROUND DATA:Obstructive jaundice is associated with hypodipsia, depletion of extracellular water, alterations of the water and sodium regulating hormones, and an increased incidence of re...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199401000-00012
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To analyze outcomes after open small-incision surgery (minilaparotomy) and laparoscopic surgery for gallstone disease in general surgical practice. METHODS:This study was a randomized, single-blind, multicenter trial comparing laparoscopic cholecystectomy (LC) to minilaparotomy cholecystectomy (MC). Both ele...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00000658-200112000-00005
更新日期:2001-12-01 00:00:00
abstract::Ileovesical and ileosigmoid fistulae were found to coexist in 22 patients with Crohn's ileocolitis. Persistent or recurrent urinary tract infection was a complaint in all cases, and 11 patients reported pneumaturia and/or fecaluria. Thus, bladder involvement was either suspected or clinically apparent in each patient....
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198801000-00010
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To prospectively characterize changes in body weight, satiety, and postprandial gut hormone profiles following esophagectomy. BACKGROUND:With improved oncologic outcomes in esophageal cancer, there is an increasing focus on functional status and health-related quality of life in survivorship. Early satiety a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001918
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy of remote ischemic conditioning (RIC) on organ protection after hemorrhagic shock/resuscitation (S/R) in a murine model. BACKGROUND:Ischemia/reperfusion resulting from S/R contributes to multiple organ dysfunction in trauma patients. We hypothesized that RIC before shock (remote isch...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000877
更新日期:2015-06-01 00:00:00
abstract::The abilities of polymorphonuclear leukocytes (PMN) and pulmonary alveolar macrophages (PAM), to demonstrate chemotaxis, phagocytosis, and superoxide release after bile duct ligation in the rat were investigated to determine the effect of cholestasis on nonspecific cellular immune mechanisms. Chemotactic response to C...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198711000-00004
更新日期:1987-11-01 00:00:00
abstract::Thirty-eight cases of carcinoma of the ampulla of Vater are presented. The diagnosis has been confirmed at laparatomy in all patients. Three operations were done, a pancreaticoduodenal resection in 23 patients, a biliary-enteric bypass in 7 patients and a biliary-enteric bypass plus excision of tumor in 8 patients. Th...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197604000-00002
更新日期:1976-04-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection. BACKGROUND:Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening progn...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002123
更新日期:2018-06-01 00:00:00
abstract::Twenty patients with extremity soft tissue tumors were prospectively evaluated with magnetic resonance imaging (MRI) and computed tomography (CT) scans with subsequent anatomic correlation of surgical findings. MRI and CT had a similar percentage of accuracy in assessing tumor relationship with major neurovascular (80...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198704000-00002
更新日期:1987-04-01 00:00:00
abstract::Two patients with aortic abdominal aneurysms in association with horseshoe kidney are presented, making a total of 34 cases recorded in the literature. In 29 patients, the aneurysm was resected and five patients were non-resectable. Because of the abnormalities in vascular supply to the abnormal kidney, it is importan...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197503000-00015
更新日期:1975-03-01 00:00:00
abstract::In a prospective, block-randomized, multicenter study, the safety and efficacy of cefoxitin in preoperative prophylaxis were studied. 1735 patients undergoing appendectomy were evaluable, and half of these patients received 2 g of cefoxitin before undergoing operation. The patients were divided into three groups: pati...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00000658-198903000-00010
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVE:To validate the authors' initial hypothesis-generating observation that eukaryotic initiation factor 4E (eIF4E) protein elevation predicts a higher cancer recurrence rate in patients with stage 1 to 3 breast cancer. SUMMARY BACKGROUND DATA:Tumor size and nodal status continue to be the two most important ind...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200205000-00016
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:To determine the optimal management of symptomatic non-parasitic liver cysts. SUMMARY BACKGROUND DATA:Management options for symptomatic nonparasitic liver cysts lack substantiation through comparative studies with respect to safety and long-term effectiveness. METHODS:A retrospective review of the surgical...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199808000-00004
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:To evaluate discrepancies between trial registry entries and final reports of randomized controlled trials (RCTs) published in major general surgical journals. BACKGROUND:Health care decisions are based on published results in peer-reviewed journals. Mandatory trial registration was introduced to increase tr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318283cf7f
更新日期:2013-06-01 00:00:00
abstract::In an attempt to determine the best provocative test for the diagnosis of gastrinoma, ten normal subjects, 13 patients with known gastrinoma, and one patient with presumed gastrinoma were administered four regimens: (1) rapid calcium infusion (2 mg Ca++/kg/min), (2) secretin (2 clinical units (CU)/kg/bolus), (3) long ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198305000-00015
更新日期:1983-05-01 00:00:00
abstract::The dilution technique for determining cardiac output using indocyanine green dye is limited in patients weighing less than 20 kg because of the obligatory volume loss. Reproducible achieved using the green dye dilution method by the establishment of a low flow peripheral arteriovenous shunt. The shunt materials were ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198001000-00020
更新日期:1980-01-01 00:00:00
abstract::From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our department. Operability was 90% (232/257); overall resectability, 77% (198/257), and for the operated group, 85% (198/232). Hospital mortality rate was 9.6% but decreased to 3% over the period 1986 to 1988. There wer...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199211000-00010
更新日期:1992-11-01 00:00:00