Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas
Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas
复制标题
胰腺导管内乳头状和粘液性肿瘤手术切除后的结果
DOI：
10.1111/j.1572-0241.2000.01764.x
复制
发表时间：
2000
影响因子：
9.8
通讯作者：
J. Barbier
中科院分区：
文献类型：
--
作者：
E. Cuillerier;C. Cellier;L. Palazzo;J. Devière;P. Wind;F. Rickaert;P. Cugnenc;M. Cremer;J. Barbier
目的：胰腺导管内乳头状黏液性肿瘤(IPMT)的治疗通常需要手术治疗。本研究的目的是根据肿瘤的组织学性质和手术类型评估患者术后复发的风险。方法：根据肿瘤的性质(侵袭性癌或非侵袭性肿瘤)、手术类型(部分或全部胰腺切除)和淋巴结状况，对45例接受部分胰腺切除术(n=35)或全胰腺切除术(n=10)的IPMT患者的预后进行分析。20例浸润性癌患者中有7例死亡(35%)，26例非浸润性肿瘤患者中有1例死亡(p<；0.05)。在7例非侵袭性肿瘤患者中，有2例在切除切缘受累的胰腺部分切除术后复发，而在13例无肿瘤切缘的患者中无一例复发。在浸润性癌患者中，1例全胰腺切除术后复发，6例胰腺部分切除术后边缘无病变，6例胰腺部分切除术后边缘受累。在浸润性癌患者中，全胰腺切除和无淋巴结转移独立地与低复发风险相关。结论：IPMT的处理方法如下：1)对于非侵袭性肿瘤患者，应在冰冻切片检查的指导下进行胰腺部分切除，直至获得无瘤切缘；2)对于浸润性癌患者，全胰腺切除术似乎最有可能治愈患者，但应根据患者的一般情况和年龄进行讨论。
OBJECTIVE:Treatment of intraductal papillary and mucinous tumors of pancreas (IPMT) usually requires surgery. The objective of this study was to evaluate the risk of recurrence in patients after surgery according to the histological nature of the neoplasm and the type of surgery.METHODS:The outcome of 45 patients who underwent partial pancreatectomy (n = 35) or total pancreatectomy (n = 10) for IPMT was studied according to the nature of the neoplasm (invasive carcinoma or noninvasive neoplasm), type of surgery (partial or total pancreatectomy), and lymph nodes status.RESULTS:The overall 3-yr actuarial survival rate was 83%. Death occurred in seven of 20 (35%) patients with invasive carcinoma and in one of 26 (4%) patients with noninvasive tumors (p < 0.05). There were two recurrences in the seven patients with noninvasive neoplasm who underwent partial pancreatectomy with involved resection margins, and none in the 13 patients with disease-free margins. In patients with invasive carcinoma, there was one recurrence after total pancreatectomy, six after partial pancreatectomy with disease-free margins and six after partial pancreatectomy with involved margins. In patients with invasive carcinoma, total pancreatectomy and the absence of lymph nodes involvement were independently associated with a low risk of recurrence.CONCLUSIONS:IPMT may be managed as follows: 1) in patients with noninvasive neoplasms, partial pancreatic resection should be guided by frozen section examination until disease-free margins are obtained; and 2) in patients with invasive carcinoma, total pancreatectomy seems most likely to cure the patient, but should be discussed according to the general status and the age.