Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer
Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer
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DOI：
10.1007/s11605-011-1748-7
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发表时间：
2012-01-01
影响因子：
3.2
通讯作者：
Fleming, Jason B.
中科院分区：
文献类型：
--
作者：
Katz, Matthew H. G.;Wang, Huamin;Fleming, Jason B.
为了确定新辅助放化疗和标准化的上级肠系膜动脉剥离对局限性胰腺癌患者肿瘤学结局的影响，对2004年至2008年间接受胰腺癌切除术的194例胰腺癌患者进行了评价。所有病例均直接沿上级肠系膜动脉沿着行腹膜后分离。采用标准的组织病理学方案测量癌细胞和上级肠系膜动脉之间的“上级肠系膜动脉（SMA）边缘距离”，76%的患者接受了新辅助放化疗。4%的患者SMA边缘阳性，但另外22%边缘阴性的患者SMA边缘距离为千分之一货币符号1 mm。术前CT图像高估了73%病例的SMA边缘距离。接受放化疗的患者SMA边缘距离比未接受放化疗的患者长。接受放化疗且SMA切缘> 1 mm的患者复发率最低。多变量分析显示，新辅助放化疗和较低的估计失血量与较长的无进展生存期独立相关。术前放化疗和上级肠系膜动脉的细致解剖使癌细胞与SMA边缘之间的距离最大化，并可能影响局部控制。
To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma.One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retroperitoneal dissection was performed directly along the superior mesenteric artery in all cases. A standard histopathologic protocol that measured the "superior mesenteric artery (SMA) margin distance" between cancer cells and the superior mesenteric artery was employed.Seventy-six percent of patients received neoadjuvant chemoradiation. The SMA margin was positive in 4% of patients but an additional 22% of patients with a negative margin had a SMA margin distance of a parts per thousand currency sign1 mm. Preoperative CT images overestimated the SMA margin distance in 73% of cases. Patients who received chemoradiation had longer SMA margin distances than those who did not. Patients who received chemoradiation and had a SMA margin of > 1 mm had the lowest recurrence rates. Administration of neoadjuvant chemoradiation and lower estimated blood loss were independently associated with longer progression-free survival on multivariate analysis.Preoperative chemoradiation and meticulous dissection of the superior mesenteric artery maximize the distance between cancer cells and the SMA margin and may influence locoregional control.