Pancreatic resection for M1 pancreatic ductal adenocarcinoma
Pancreatic resection for M1 pancreatic ductal adenocarcinoma
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DOI：
10.1245/s10434-006-9131-8
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发表时间：
2007-01-01
影响因子：
3.7
通讯作者：
Buechler, Markus W.
中科院分区：
文献类型：
--
作者：
Shrikhande, Shailesh V.;Kleff, Joerg;Buechler, Markus W.
背景：胰腺手术安全性的提高导致考虑更积极的方法，如原发性胰腺导管腺癌（PDAC）合并转移性疾病（M1）的切除术。方法：从316例R0/R1胰腺切除术的PDAC数据库中，回顾性地确定了29例接受胰腺切除术并切除相关转移性疾病（主动脉腔间淋巴结清扫，肝脏切除术和/或多器官切除术）的患者。采用Kaplan-Meier估计、log rank检验和Fisher精确检验对围手术期、临床病理参数和总生存期进行探索性数据分析。结果：M1病（n = 29）的R0/R1胰腺切除术的总体住院死亡率和发病率分别为0%和24.1%，而M0病（n = 287）的R0/R1胰腺切除术的总体住院死亡率和发病率分别为4.2%和35.2%。M1患者的中位总生存时间为13.8个月（95%可信区间[CI]， 11.4-20.5），估计1年总生存率为58.9% （95% CI, 34.8-76.7）。主动脉腔间淋巴结转移患者的中位生存期为27个月（95% CI, 9.6-27.0），而肝脏和腹膜转移患者的中位生存期分别为11.4个月（95% CI, 7.8-16.5）和12.9个月（95% CI, 7.2-20.5）。结论：在高度选定的患者中，M1疾病胰腺切除术的安全性是可以接受的。主动脉腔间淋巴结切除术后的生存率与其他不构成M1疾病的淋巴结相当。肝和腹膜转移的切除虽然在本系列中是安全的，但在进一步的对照试验进行之前，不能普遍推荐。
Background: Improved safety of pancreatic surgery has led to consideration of more aggressive approaches, such as resection for primary pancreatic ductal adenocarcinoma (PDAC) with metastatic disease (M1).Methods: A total of 29 patients who underwent pancreatic resection with resection of associated metastatic disease (interaortocaval lymph node dissection, liver resection, and/or multiorgan resections) were retrospectively identified from a database of 316 R0/R1 pancreatic resections for PDAC. An explorative data analysis of perioperative and clinicopathological parameters, and overall survival was performed by Kaplan-Meier estimation, log rank test, and Fisher's exact test.Results: The overall in-hospital mortality and morbidity of R0/R1 pancreatic resections for M1 disease (n = 29) was 0% and 24.1%, compared with 4.2% and 35.2% of R0/R1 pancreatic resections for M0 disease (n = 287). The median overall survival time was 13.8 months (95% confidence interval [CI], 11.4-20.5), and the estimated 1-year overall survival rate was 58.9% (95% CI, 34.8-76.7) for patients with M1 disease. The median survival in those with metastatic interaortocaval lymph nodes was 27 months (95% CI, 9.6-27.0), whereas it was 11.4 months (95% CI, 7.8-16.5) and 12.9 months (95% CI, 7.2-20.5) for those with liver and peritoneal metastases, respectively.Conclusions: Pancreatic resections with M1 disease can be performed with acceptable safety in highly selected patients. The survival after interaortocaval lymph node resection is comparable to that of other lymph nodes that do not constitute M1 disease. Resection of liver and peritoneal metastases, although safe in this series, cannot be generally recommended until further controlled trials can be conducted.