Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer - Long-term results
Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer - Long-term results
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DOI：
10.1097/01.sla.0000258608.52615.5a
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发表时间：
2007-07-01
影响因子：
9
通讯作者：
Hazama, Kazuaki
中科院分区：
文献类型：
--
作者：
Hirano, Satoshi;Kondo, Satoshi;Hazama, Kazuaki
目的：分析远端胰腺切除术联合腹腔轴整块切除术（DP-CAR）的长期结果，这是一种新设计的治疗局部晚期胰体癌的扩展手术方法。 背景资料摘要：胰体癌通常累及肝总动脉和/或腹腔轴，被认为是一种无法切除的疾病。我们之前报道了DP-CAR在10名患者和3个初步病例中的可行性和安全性；方法：1998年5月至2005年9月期间，23名患者接受了DP-CAR治疗。由于从肠系膜上动脉经由胰十二指肠弓的侧支动脉通路早期发育，因此不需要重建动脉系统。我们术前常规采用肝总动脉弹簧圈栓塞扩大侧支通路。结果：尽管发病率较高（48%），但术后死亡率为0%。术后主要并发症为胰瘘和缺血性胃病。与预期相反，术后腹泻很轻微。 10例患者术前顽固性腹部和/或背部疼痛，术后立即完全缓解。 21 名患者 (91%) 的手术切缘组织学呈阴性。估计总体 1 年和 5 年生存率分别为 71% 和 42%，中位生存期为 21.0 个月。 6 名患者的复发部位为肝脏，2 名患者的复发部位为局部复发。结论：DP-CAR 具有较高的 R0 可切除率，并且有可能在选定的患者中实现完全的局部控制。持续的早期肝脏复发可能表明 DP-CAR 可用于治疗较晚期的疾病。
Objective: To analyze the long-term results of distal pancreatectomy with en bloc celiac axis resection (DP-CAR), a newly designed extended surgical procedure for locally advanced cancer of the pancreatic body.Summary Background Data: Pancreatic body cancer often involves the common hepatic artery and/or the celiac axis and is regarded as an unresectable disease. We previously reported the feasibility and safety of DP-CAR in 10 patients and 3 preliminary cases; however, the long-term results are unknown.Methods: Between May 1998 and September 2005, 23 patients underwent DP-CAR. No reconstruction of the arterial system was required because of early development of the collateral arterial pathways via the pancreatoduodenal arcades from the superior mesenteric artery. We routinely used preoperative coil embolization of the common hepatic artery to enlarge the collateral pathways.Results: The postoperative mortality rate was 0%, despite a high morbidity rate (48%). The chief postoperative complications were pancreatic fistula and ischemic gastropathy. Contrary to expectations, postoperative diarrhea was mild. Preoperative intractable abdominal and/or back pain in 10 patients was completely alleviated immediately after surgery. The surgical margins were histologically negative in 21 patients (91%). The estimated overall 1- and 5-year survival rates were 71% and 42%, respectively, and the median survival was 21.0 months. The sites of recurrence were the liver in 6 patients and local recurrence in 2.Conclusions: DP-CAR offers a high R0 resectability rate and may potentially achieve complete local control in selected patients. The persisting early hepatic recurrence may indicate DP-CAR for the treatment of less advanced disease.