Zi Yin1, Yu Zhou2, Baohua Hou2, Tingting Ma3, Min Yu2, Chuanzhao Zhang2, Xin Lu2, Zhixiang Jian4. 1. General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China. yinzi@outlook.com. 2. General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China. 3. Gynaecology and Obstetrics Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. 4. General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China. janezhix@yeah.net.
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.
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 cancerpatients, 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.
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: Kathleen K Christians; Susan Tsai; Anna Mahmoud; Paul Ritch; James P Thomas; Lauren Wiebe; Tracy Kelly; Beth Erickson; Huamin Wang; Douglas B Evans; Ben George Journal: Oncologist Date: 2014-02-25
Authors: Tony C Y Pang; Oliver Wilson; Manuel A Argueta; Thomas J Hugh; Angela Chou; Jaswinder S Samra; Anthony J Gill Journal: Pathology Date: 2014-04 Impact factor: 5.306
Authors: David A Kooby; Neha L Lad; Malcolm H Squires; Shishir K Maithel; Juan M Sarmiento; Charles A Staley; N Volkan Adsay; Bassel F El-Rayes; Sharon M Weber; Emily R Winslow; Clifford S Cho; Kathryn A Zavala; David J Bentrem; Mark Knab; Syed A Ahmad; Daniel E Abbott; Jeffrey M Sutton; Hong Jin Kim; Jen Jen Yeh; Rachel Aufforth; Charles R Scoggins; Robert C Martin; Alexander A Parikh; Jamie Robinson; Yassar M Hashim; Ryan C Fields; William G Hawkins; Nipun B Merchant Journal: Ann Surg Date: 2014-09 Impact factor: 12.969
Authors: K A Bickenbach; M Gonen; Laura H Tang; Eileen O'Reilly; Karyn Goodman; M F Brennan; M I D'Angelica; R P Dematteo; Y Fong; W R Jarnagin; P J Allen Journal: Ann Surg Oncol Date: 2011-12-01 Impact factor: 5.344
Authors: C Max Schmidt; Jeffrey Glant; Jordan M Winter; Jason Kennard; Jennifer Dixon; Qianqian Zhao; Thomas J Howard; James A Madura; Atilla Nakeeb; Henry A Pitt; John L Cameron; Charles J Yeo; Keith D Lillemoe Journal: Surgery Date: 2007-10 Impact factor: 3.982
Authors: Ioannis T Konstantinidis; Andrew L Warshaw; Jill N Allen; Lawrence S Blaszkowsky; Carlos Fernandez-Del Castillo; Vikram Deshpande; Theodore S Hong; Eunice L Kwak; Gregory Y Lauwers; David P Ryan; Jennifer A Wargo; Keith D Lillemoe; Cristina R Ferrone Journal: Ann Surg Date: 2013-04 Impact factor: 12.969
Authors: Jennifer L Gnerlich; Samuel R Luka; Anjali D Deshpande; Bernard J Dubray; Joshua S Weir; Danielle H Carpenter; Elizabeth M Brunt; Steven M Strasberg; William G Hawkins; David C Linehan Journal: Arch Surg Date: 2012-08
Authors: David K Chang; Amber L Johns; Neil D Merrett; Anthony J Gill; Emily K Colvin; Christopher J Scarlett; Nam Q Nguyen; Rupert W L Leong; Peter H Cosman; Mark I Kelly; Robert L Sutherland; Susan M Henshall; James G Kench; Andrew V Biankin Journal: J Clin Oncol Date: 2009-04-27 Impact factor: 44.544
Authors: Emrullah Birgin; Erik Rasbach; Patrick Téoule; Felix Rückert; Christoph Reissfelder; Nuh N Rahbari Journal: Sci Rep Date: 2020-12-17 Impact factor: 4.379