Resection margin involvement and tumour origin in pancreatic head cancer
Background: Assessment of the origin of adenocarcinoma in pancreatoduodenectomy specimens (pancreatic, ampullary or biliary) and resection margin status is not performed in a consistent manner in different centres. The aim of this review was to identify the impact of such variations on patient outco...
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| Veröffentlicht in: | British journal of surgery 2012-08, Vol.99 (8), p.1036-1049 |
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| container_title | British journal of surgery |
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| creator | Verbeke, C. S. Gladhaug, I. P. |
| description | Background:
Assessment of the origin of adenocarcinoma in pancreatoduodenectomy specimens (pancreatic, ampullary or biliary) and resection margin status is not performed in a consistent manner in different centres. The aim of this review was to identify the impact of such variations on patient outcome.
Methods:
A systematic literature search for articles on pancreatic, ampullary, distal bile duct and periampullary cancer was performed, with special attention to data on resection margin status, pathological examination and outcome.
Results:
The frequent reclassification of tumour origin following slide review, and the wide variation in published incidence of pancreatic (33–89 per cent), ampullary (5–42 per cent) and distal bile duct (5–38 per cent) cancers indicate that the histopathological distinction between the three cancer groups is less accurate than generally believed. Recent studies have shown that the wide range of rates of microscopic margin involvement (R1) in pancreatoduodenectomy specimens (18–85, 0–27 and 0–72 per cent respectively for pancreatic, ampullary and distal bile duct cancers) is mainly caused by differences in pathological assessment rather than surgical practice and patient selection. As a consequence of the existing inconsistency in reporting of these data items, the clinical significance of microscopic margin involvement in each of the three cancer groups remains unclear.
Conclusion:
Inaccurate and inconsistent distinction between pancreatic, ampullary and distal bile duct cancer, combined with inaccuracies in resection margin assessment, results in obfuscation of key clinicopathological data. Specimen dissection technique plays a key role in the quality of the assessment of both tumour origin and margin status. Unless the pathological examination is meticulous and standardized, comparison of results between centres and observations in multicentre trials will remain of limited value. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Standardization is vital |
| doi_str_mv | 10.1002/bjs.8734 |
| format | Article |
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Assessment of the origin of adenocarcinoma in pancreatoduodenectomy specimens (pancreatic, ampullary or biliary) and resection margin status is not performed in a consistent manner in different centres. The aim of this review was to identify the impact of such variations on patient outcome.
Methods:
A systematic literature search for articles on pancreatic, ampullary, distal bile duct and periampullary cancer was performed, with special attention to data on resection margin status, pathological examination and outcome.
Results:
The frequent reclassification of tumour origin following slide review, and the wide variation in published incidence of pancreatic (33–89 per cent), ampullary (5–42 per cent) and distal bile duct (5–38 per cent) cancers indicate that the histopathological distinction between the three cancer groups is less accurate than generally believed. Recent studies have shown that the wide range of rates of microscopic margin involvement (R1) in pancreatoduodenectomy specimens (18–85, 0–27 and 0–72 per cent respectively for pancreatic, ampullary and distal bile duct cancers) is mainly caused by differences in pathological assessment rather than surgical practice and patient selection. As a consequence of the existing inconsistency in reporting of these data items, the clinical significance of microscopic margin involvement in each of the three cancer groups remains unclear.
Conclusion:
Inaccurate and inconsistent distinction between pancreatic, ampullary and distal bile duct cancer, combined with inaccuracies in resection margin assessment, results in obfuscation of key clinicopathological data. Specimen dissection technique plays a key role in the quality of the assessment of both tumour origin and margin status. Unless the pathological examination is meticulous and standardized, comparison of results between centres and observations in multicentre trials will remain of limited value. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Standardization is vital</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.8734</identifier><identifier>PMID: 22517199</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Ampulla of Vater - pathology ; Ampulla of Vater - surgery ; Bile Duct Neoplasms - pathology ; Bile Duct Neoplasms - surgery ; Biological and medical sciences ; Common Bile Duct Neoplasms - pathology ; Common Bile Duct Neoplasms - surgery ; Diagnosis, Differential ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Humans ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Medical sciences ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy - methods ; Prognosis ; Tumor Burden ; Tumors</subject><ispartof>British journal of surgery, 2012-08, Vol.99 (8), p.1036-1049</ispartof><rights>Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3904-9dbf520ce8e3e4f756ef333a3ffc7e8a3d27b19ae57c0ccc22aa5ccc62fbbe4d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.8734$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.8734$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26103134$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22517199$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Verbeke, C. S.</creatorcontrib><creatorcontrib>Gladhaug, I. P.</creatorcontrib><title>Resection margin involvement and tumour origin in pancreatic head cancer</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background:
Assessment of the origin of adenocarcinoma in pancreatoduodenectomy specimens (pancreatic, ampullary or biliary) and resection margin status is not performed in a consistent manner in different centres. The aim of this review was to identify the impact of such variations on patient outcome.
Methods:
A systematic literature search for articles on pancreatic, ampullary, distal bile duct and periampullary cancer was performed, with special attention to data on resection margin status, pathological examination and outcome.
Results:
The frequent reclassification of tumour origin following slide review, and the wide variation in published incidence of pancreatic (33–89 per cent), ampullary (5–42 per cent) and distal bile duct (5–38 per cent) cancers indicate that the histopathological distinction between the three cancer groups is less accurate than generally believed. Recent studies have shown that the wide range of rates of microscopic margin involvement (R1) in pancreatoduodenectomy specimens (18–85, 0–27 and 0–72 per cent respectively for pancreatic, ampullary and distal bile duct cancers) is mainly caused by differences in pathological assessment rather than surgical practice and patient selection. As a consequence of the existing inconsistency in reporting of these data items, the clinical significance of microscopic margin involvement in each of the three cancer groups remains unclear.
Conclusion:
Inaccurate and inconsistent distinction between pancreatic, ampullary and distal bile duct cancer, combined with inaccuracies in resection margin assessment, results in obfuscation of key clinicopathological data. Specimen dissection technique plays a key role in the quality of the assessment of both tumour origin and margin status. Unless the pathological examination is meticulous and standardized, comparison of results between centres and observations in multicentre trials will remain of limited value. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Standardization is vital</description><subject>Ampulla of Vater - pathology</subject><subject>Ampulla of Vater - surgery</subject><subject>Bile Duct Neoplasms - pathology</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Biological and medical sciences</subject><subject>Common Bile Duct Neoplasms - pathology</subject><subject>Common Bile Duct Neoplasms - surgery</subject><subject>Diagnosis, Differential</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Humans</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Medical sciences</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Prognosis</subject><subject>Tumor Burden</subject><subject>Tumors</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0F9LwzAUBfAgiptT8BNIXwRfqklu06yPbuimDIU58TGk6a1G-2cmrbpvb8emezqE-yNwDiGnjF4ySvlV-u4vhxKiPdJnEIuQs3i4T_qUUhky4NAjR96_U8qACn5IepwLJlmS9Ml0jh5NY-sqKLV7tVVgq6-6-MISqybQVRY0bVm3Lqid3VyDpa6MQ91YE7yhzgLTvdEdk4NcFx5Ptjkgz7c3i_E0nD1O7sbXs9BAQqMwydJccGpwiIBRLkWMOQBoyHMjcagh4zJliUYhDTXGcK616DLmeZpilMGAXGz-Xbr6s0XfqNJ6g0WhK6xbrxjlUSRjIXhHz7a0TUvM1NLZruNK_bXvwPkWaG90kbuuifU7FzMKDKLOhRv3bQtc_d8ZVev1Vbe-Wq-vRvdP69x56xv8-ffafahYghTq5WGiRovpIqHjuWLwC0vdhmo</recordid><startdate>201208</startdate><enddate>201208</enddate><creator>Verbeke, C. S.</creator><creator>Gladhaug, I. P.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201208</creationdate><title>Resection margin involvement and tumour origin in pancreatic head cancer</title><author>Verbeke, C. S. ; Gladhaug, I. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3904-9dbf520ce8e3e4f756ef333a3ffc7e8a3d27b19ae57c0ccc22aa5ccc62fbbe4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Ampulla of Vater - pathology</topic><topic>Ampulla of Vater - surgery</topic><topic>Bile Duct Neoplasms - pathology</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Biological and medical sciences</topic><topic>Common Bile Duct Neoplasms - pathology</topic><topic>Common Bile Duct Neoplasms - surgery</topic><topic>Diagnosis, Differential</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Humans</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Medical sciences</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Prognosis</topic><topic>Tumor Burden</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Verbeke, C. S.</creatorcontrib><creatorcontrib>Gladhaug, I. P.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Verbeke, C. S.</au><au>Gladhaug, I. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Resection margin involvement and tumour origin in pancreatic head cancer</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2012-08</date><risdate>2012</risdate><volume>99</volume><issue>8</issue><spage>1036</spage><epage>1049</epage><pages>1036-1049</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background:
Assessment of the origin of adenocarcinoma in pancreatoduodenectomy specimens (pancreatic, ampullary or biliary) and resection margin status is not performed in a consistent manner in different centres. The aim of this review was to identify the impact of such variations on patient outcome.
Methods:
A systematic literature search for articles on pancreatic, ampullary, distal bile duct and periampullary cancer was performed, with special attention to data on resection margin status, pathological examination and outcome.
Results:
The frequent reclassification of tumour origin following slide review, and the wide variation in published incidence of pancreatic (33–89 per cent), ampullary (5–42 per cent) and distal bile duct (5–38 per cent) cancers indicate that the histopathological distinction between the three cancer groups is less accurate than generally believed. Recent studies have shown that the wide range of rates of microscopic margin involvement (R1) in pancreatoduodenectomy specimens (18–85, 0–27 and 0–72 per cent respectively for pancreatic, ampullary and distal bile duct cancers) is mainly caused by differences in pathological assessment rather than surgical practice and patient selection. As a consequence of the existing inconsistency in reporting of these data items, the clinical significance of microscopic margin involvement in each of the three cancer groups remains unclear.
Conclusion:
Inaccurate and inconsistent distinction between pancreatic, ampullary and distal bile duct cancer, combined with inaccuracies in resection margin assessment, results in obfuscation of key clinicopathological data. Specimen dissection technique plays a key role in the quality of the assessment of both tumour origin and margin status. Unless the pathological examination is meticulous and standardized, comparison of results between centres and observations in multicentre trials will remain of limited value. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Standardization is vital</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>22517199</pmid><doi>10.1002/bjs.8734</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2012-08, Vol.99 (8), p.1036-1049 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Wiley Online Library All Journals |
| subjects | Ampulla of Vater - pathology Ampulla of Vater - surgery Bile Duct Neoplasms - pathology Bile Duct Neoplasms - surgery Biological and medical sciences Common Bile Duct Neoplasms - pathology Common Bile Duct Neoplasms - surgery Diagnosis, Differential Gastroenterology. Liver. Pancreas. Abdomen General aspects Humans Liver. Biliary tract. Portal circulation. Exocrine pancreas Medical sciences Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - methods Prognosis Tumor Burden Tumors |
| title | Resection margin involvement and tumour origin in pancreatic head cancer |
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