Assessment of the interface between retroperitoneal fat infiltration of pancreatic ductal carcinoma and the major artery by multidetector-row computed tomography: surgical outcomes and correlation with histopathological extension.
Assessment of the interface between retroperitoneal fat infiltration of pancreatic ductal carcinoma and the major artery by multidetector-row computed tomography: surgical outcomes and correlation with histopathological extension.
复制标题
通过多排计算机断层扫描评估胰腺导管癌腹膜后脂肪浸润和大动脉之间的界面：手术结果以及与组织病理学扩展的相关性。
DOI：
10.1007/s00268-012-1618-9
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Yamamoto Y
中科院分区：
文献类型：
--
作者：
T Ooka;Y Inoue;S Hironaka;Y Mukai;S. Yamada;Yamamoto Y
背景腹膜后浸润的精确评估对于实现切缘阴性具有重要临床意义。方法回顾性分析2004年至2008年因胰腺浸润性导管癌接受宏观根治性胰十二指肠切除术的132例患者的临床资料。分析临床病理因素，包括通过多排计算机断层扫描（MDCT）将腹膜后脂肪浸润分为四组。还调查了腹膜后脂肪浸润的等级与手术结果以及各种组织病理学因素之间的关系。结果0级浸润的5年生存率为55.6%（n=8），1级浸润为38.7%（n=54），2级浸润为16.4%（n=49），3级浸润为0%（n=21）。每组的生存率均存在显着差异。胰外神经侵犯和手术切缘状态与 MDCT 证实的腹膜后脂肪浸润显着相关。根据43例病理性门静脉侵犯患者的分级分类，1级患者的5年生存率为45.9%，明显优于2级患者（P=0.007）。结论腹膜后脂肪浸润分级标准可作为胰头癌胰十二指肠切除术后生存的预测指标。即使存在组织病理学门静脉侵犯，胰十二指肠切除术联合门静脉切除也可为 1 级腹膜后脂肪浸润患者提供良好的生存率。
BackgroundPrecise assessment of retroperitoneal invasion is clinically important to allow the achievement of negative margin resections.MethodsThe clinical records of 132 patients who underwent macroscopic curative pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas between 2004 and 2008 were retrospectively examined. The clinicopathological factors, including retroperitoneal fat infiltration classified into four groups by multidetector-row computed tomography (MDCT), were analyzed. The relationship between the grade of retroperitoneal fat infiltration and surgical outcomes, as well as various histopathological factors, was also investigated.ResultsThe 5 year survival rate was 55.6 % for grade 0 infiltration (n= 8), 38.7 % for grade 1 (n= 54), 16.4 % for grade 2 (n= 49), and 0 % for grade 3 (n= 21). There were significant differences in survival in each group. Extrapancreatic nerve invasion and the surgical margin status were significantly associated with retroperitoneal fat infiltration demonstrated on MDCT. According to the grading classification among the 43 patients with pathological portal vein invasion, the 5 year survival rate was 45.9 % for patients with grade 1, which was significantly better survival that those with grade 2 (P= 0.007).ConclusionThe grading criteria for retroperitoneal fat infiltration may be useful as a predictor of survival after pancreaticoduodenectomy for pancreatic head carcinoma. Pancreaticoduodenectomy with portal vein resection could provide favorable survival in patients with grade 1 retroperitoneal fat infiltration, even if histopathological portal vein invasion is present.