Non-radical resection versus bypass procedure for XXXX - A consecutive series and systematic review.

@entity1 @entity788 @entity5
BACKGROUND: Most survival studies comparing non-radical resections to bypass surgery in @entity1 with @entity788 often do not differentiate between an R1 and R2 resection. The aim of this study was to evaluate whether non-radical R1 and R2 resections have better postoperative outcomes and survival compared to a palliative bypass. METHODS: A single center cohort study was performed analyzing mortality, morbidity and 1-year survival after R1 ( @entity5 cells within 1  mm from the circumferential margin), R2 and bypass surgery in @entity1 with @entity788 . For the systematic review, studies were identified comparing R1 or R2 resections with bypass, in @entity1 with @entity788 . Postoperative outcomes were compared including the cohort study. RESULTS: The cohort study (n=405) showed higher morbidity rates after R1 (n=191) and R2 (n=11) resections compared to bypass (52% and 73% vs. 34%, p  <  0.01). In-hospital mortality did not differ (overall 1.7%). 1-year survival rates were 71%, 46% and 32% after R1, R2 resection and bypass (p=0.6 between R2 and bypass). The systematic review identified 8 studies, after including the cohort study 1535 @entity1 were analyzed. Increased morbidity after R1-R2 resection (48%) compared to bypass (30-34%) was found. Median survival was 14-18 months after R1 resection vs. 9-13 months after bypass and 8.5-11.5 months after R2 resection vs. 7.5-10.7 months after bypass. CONCLUSION: An R2 resection should be avoided in @entity1 with @entity788 due to its poor prognosis. Survival benefit after an R1 resection, as compared to bypass surgery, justifies a resection despite the increased morbidity rate.
