Metastases to the pancreas and their surgical extirpation
Metastases to the pancreas and their surgical extirpation
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DOI：
10.1001/archsurg.133.4.413
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发表时间：
1998-04-01
影响因子：
--
通讯作者：
Warshaw, AL
中科院分区：
文献类型：
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作者：
Z'graggen, K;Fernández-del Castillo, C;Warshaw, AL
背景：胰腺是一种少见但偶尔发生的转移灶，尤其是肾癌和肺癌的转移灶。胰腺可能是唯一确定的扩散位点，因此可能为胰腺切除术提供显著缓解甚至治愈的机会。目的：报道胰腺转移患者的治疗和预后。设计：为期五年的调查。单位：三级转诊中心。患者：1991年1月1日至1995年12月31日，发现10例明显转移到胰腺的患者。所有患者随访至死亡或至1997年9月。结果：患者均曾接受过肺癌（n=4）、肾细胞癌（n=2）、肉瘤（n=2）、乳腺癌（n=1）、子宫内膜癌（n=1）的治疗。初次治疗到出现转移的时间间隔平均为70个月（肺癌14-24个月，肾细胞癌10年和22年，肉瘤4年和6年，乳腺癌8年，子宫内膜癌36个月）。转移最初被误诊为原发性胰腺癌的7例患者。4例患者（伴有肾细胞癌和肉瘤）采用全胰腺切除术（n=3）或Whipple切除术（n=1）完全切除肿瘤。诊断后平均生存22个月。4例接受胰腺切除术的患者中有2例在胰腺切除术后20个月和25个月仍然存活。结论：胰腺可能是转移的主要部位，也可能是唯一的转移位点，特别是在某些胰腺外恶性肿瘤治疗数年后。识别和手术治疗可以提供有价值的缓解和长期生存。
Background: The pancreas is an unusual but occasionally favored site for metastases, notably from carcinomas of the kidney and lung. The pancreas may be the only identified locus of spread, and therefore may provide an opportunity for significant palliation or even cure using pancreatectomy.Objective: To report the treatment and outcome of patients presenting with metastases to the pancreas.Design: Five-year survey.Setting: Tertiary referral center.Patients: Ten patients with apparently isolated metastases to the pancreas were identified from January 1, 1991, to December 31, 1995. All patients were followed up until death or to September 1997.Results: The patients had been treated previously for carcinoma of the lung (n=4), renal cell carcinoma (n=2), sarcoma (n=2), breast carcinoma (n=1), and endometrial carcinoma (n=1). The interval between primary treatment and presentation of the metastases averaged 70 months (14-24 months for lung cancer, 10 and 22 years for renal cell carcinoma, 4 and 6 years for sarcoma, 8 years for breast cancer, and 36 months for endometrial carcinoma). Metastases were initially misdiagnosed as primary pancreatic cancers in 7 patients. In 4 patients (those with renal cell cancer and sarcomas), the tumor was completely resected using total pancreatectomy (n=3) or Whipple resection (n=1). Survival after diagnosis averaged 22 months. Two of the 4 patients undergoing pancreatic resection remain alive and well 20 and 25 months after pancreatectomy.Conclusions: The pancreas may be the presenting and perhaps sole locus for metastasis, typically years after treatment for certain extrapancreatic malignant neoplasms. Recognition and surgical treatment can provide worthwhile palliation and long-term survival.