The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma
The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma
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DOI：
10.1016/s1072-7515(99)00041-1
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发表时间：
1999-05-01
影响因子：
5.2
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Schwarz, RE;Harrison, LE;Brennan, MF
背景：食管癌、胃癌或结肠癌切除术时行脾切除术与较差的长期生存率相关。对于胰腺癌，这种效果尚未得到证实。研究设计：从前瞻性临床数据库中确定1983年10月至1995年10月在纪念斯隆-凯特琳癌症中心接受治疗目的胰腺腺癌切除术的患者。采用单因素和多因素非参数方法计算脾切除术对住院时间和生存的影响。结果：在332例行胰腺切除术的患者中，326例确诊为局部或区域性疾病的患者构成了研究队列。其中37例行脾切除术（11.4%）。脾切除术与远端或全胰切除术、原发位置在尾部或身体、门静脉侵犯或切除、最大肿瘤直径较大、术中出血量大于2000 mL显著相关。脾切除术不影响死亡或需要再次手术。接受脾切除术的患者输血需要量中位数较高（3比1；p = 0.002）。不论是否切除脾，术后中位住院时间均为15天。中位随访时间为16.3个月（存活患者为36.4个月），脾切除术的中位精算生存期为12.2个月，而未脾切除术的中位精算生存期为17.8个月（p < 0.005）。在多因素分析中，脾脏切除术成为预测术后生存降低的独立因素（p = 0.02），此外还有病理淋巴结状态（p = 0.0002）、肿瘤直径（p = 0.0004）和肿瘤分化（p = 0.007）。肿瘤在胰腺内的位置和胰腺切除术的类型不是影响生存的独立预后因素。结论：胰腺癌胰腺切除术后，脾切除术对术后恢复无显著可测影响，但对独立于疾病相关因素的长期生存有负面影响。除非肿瘤靠近或侵袭，否则在任何部位的外分泌胰腺癌手术治疗中都应避免脾切除术。[J]中华外科杂志1999；18:516-521。(C) 1999年由美国外科医师学会出版)。
Background: Splenectomy at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior longterm survival. Na such effect has yet been demonstrated for pancreatic cancer.Study Design: patients undergoing resection of pancreatic adenocarcinoma with curative intent at Memorial Sloan-Kettering Cancer Center between October 1983 and October 1995 were identified from a prospective clinical database. The impact of splenectomy on hospital stay and survival was calculated with univariate and multivariate nonparametric methods.Results: Of 332 patients undergoing pancreatectomy, 326 with confirmed Local or regional disease only formed the study cohort. Of these, 37 underwent concomitant splenectomy (11.4%). Splenectomy was significantly correlated with distal or total pancreatectomy, primary location in tail or body, portal vein invasion or resection, a larger maximal tumor diameter, and an operative blood loss of greater than 2,000 mL. Death or need for reoperation was not affected by splenectomy. patients undergoing splenectomy had a higher median transfusion requirement (3 versus 1; p = 0.002). The median postoperative length of stay was 15 days regardless of splenectomy. At a median followup of 16.3 months (36.4 months for surviving patients), the median actuarial survival was 12.2 months with splenectomy versus 17.8 months without splenectomy (p < 0.005). On multivariate analysis, splenectomy emerged as an independent factor predictive of decreased postoperative survival (p = 0.02), in addition to pathologic lymph node status (p = 0.0002), tumor diameter (p = 0.0004), and tumor differentiation (p = 0.007). Tumor location within the pancreas and the type of pancreatectomy were not independent prognostic factors influencing survival.Conclusions: After pancreatectomy for pancreatic cancer, splenectomy has no significant measurable impact on postoperative recovery, but has a negative influence on longterm survival independent of disease-related factors. Unless required because of tumor proximity or invasion, splenectomy should be avoided in the operative treatment of exocrine pancreatic cancer at any location. (J Am Coll Surg 1999;188:516-521. (C) 1999 by the American College of Surgeons).