Objective:Microscopically positive resection margins(R1)in gastric cancer have been associated with poor outcomes,but evidence regarding its prognostic significance across different stages remains inconsistent.This st...Objective:Microscopically positive resection margins(R1)in gastric cancer have been associated with poor outcomes,but evidence regarding its prognostic significance across different stages remains inconsistent.This study investigated the impact of R1 resection on survival outcomes and evaluated the prognostic significance of detailed pathological characteristics of margin involvement.Methods:This retrospective study analyzed 10,165 patients who underwent curative-intent gastrectomy for gastric cancer between 2007 and 2021.Propensity score matching was performed at a 1:3 ratio between R1(n=45)and R0(n=130)cases.For R1 margins,detailed pathological assessment included involvement length,proportion,depth,and histological features.Survival outcomes were evaluated across all stages,and the impact of subsequent resection was analyzed.Results:After propensity score matching,R1 resection showed significantly lower 5-year overall survival rates compared to R0 resection across all stages(stageⅠ:60.0%vs.90.9%,P=0.008;stageⅡ:40.0%vs.83.3%,P=0.001;stageⅢ:20.0%vs.35.4%,P<0.001).In R1 cases,tumor involvement length≤1 cm(P<0.001),proportion≤10%(P=0.012),and mucosal-only involvement(P=0.004)were associated with better survival.Patients who underwent subsequent resection to achieve R0 status showed better survival than those with persistent R1 resection(53.8%vs.26.7%,P<0.001)and comparable survival to matched R0 cases(53.8%vs.46.9%,P=0.320).Conclusions:R1 resection significantly impairs survival across all stages of gastric cancer,with the extent and depth of microscopic involvement influencing prognosis.When R1 status is discovered postoperatively,subsequent resection should be considered to improve survival outcomes.展开更多
BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopat...BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.METHODS Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.RESULTS Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.CONCLUSION Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.展开更多
文摘Objective:Microscopically positive resection margins(R1)in gastric cancer have been associated with poor outcomes,but evidence regarding its prognostic significance across different stages remains inconsistent.This study investigated the impact of R1 resection on survival outcomes and evaluated the prognostic significance of detailed pathological characteristics of margin involvement.Methods:This retrospective study analyzed 10,165 patients who underwent curative-intent gastrectomy for gastric cancer between 2007 and 2021.Propensity score matching was performed at a 1:3 ratio between R1(n=45)and R0(n=130)cases.For R1 margins,detailed pathological assessment included involvement length,proportion,depth,and histological features.Survival outcomes were evaluated across all stages,and the impact of subsequent resection was analyzed.Results:After propensity score matching,R1 resection showed significantly lower 5-year overall survival rates compared to R0 resection across all stages(stageⅠ:60.0%vs.90.9%,P=0.008;stageⅡ:40.0%vs.83.3%,P=0.001;stageⅢ:20.0%vs.35.4%,P<0.001).In R1 cases,tumor involvement length≤1 cm(P<0.001),proportion≤10%(P=0.012),and mucosal-only involvement(P=0.004)were associated with better survival.Patients who underwent subsequent resection to achieve R0 status showed better survival than those with persistent R1 resection(53.8%vs.26.7%,P<0.001)and comparable survival to matched R0 cases(53.8%vs.46.9%,P=0.320).Conclusions:R1 resection significantly impairs survival across all stages of gastric cancer,with the extent and depth of microscopic involvement influencing prognosis.When R1 status is discovered postoperatively,subsequent resection should be considered to improve survival outcomes.
文摘BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.METHODS Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.RESULTS Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.CONCLUSION Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.
