D1 Distal Pancreatectomy for Left-sided Pancreatic Ductal Adenocarcinoma Is Justifiable: A Propensity-score Matched Multicenter Study
D1 Distal Pancreatectomy for Left-sided Pancreatic Ductal Adenocarcinoma Is Justifiable: A Propensity-score Matched Multicenter Study
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DOI：
10.21873/anticanres.16150
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发表时间：
2023-01-01
影响因子：
2
通讯作者：
Usuba, Teruyuki
中科院分区：
文献类型：
--
作者：
Sakamoto, Taro;Gocho, Takeshi;Usuba, Teruyuki
背景/目的：关于左侧胰腺导管腺癌(PDAC)最佳淋巴清扫范围的证据很少。本研究的目的是比较接受D1DP和D2DP治疗左侧PDAC的患者的长期结果。患者和方法：在日本经济大学附属的四个机构接受左侧动脉导管未闭(DP)的患者为研究对象。将患者分为D_1组和D_2组。比较两组患者治疗前后的临床特征、总生存期(OS)和无复发生存期(RFS)。结果：在145例左侧PDAC患者中，55例接受了D1DP，90例接受了D2DP，其中38对匹配进入PSM分析队列。在不匹配的队列中，d1和d2组在OS(中位数2.51年对3.07年；p=0.709)和RFS(中位数1.47年对1.27年；p=0.565)方面没有显著差异。经PSM治疗后，两组的OS(中位数2.37年对3.56年；p=0.407)和RFS(中位数1.35年对1.11年；p=0.542)无显著差异。在局部和全身复发部位的比较中，两组之间没有显著差异(p=0.500)。结论：左侧PDAC的D1DP远期存活率不低于D2DP。在一个多学科治疗PDAC的重要性已经被记录在案的时代，应该避免不必要的延长手术。
Background/Aim: Evidence on the optimal extent of lymph node dissection for left-sided pancreatic ductal adenocarcinoma (PDAC) is scarce. The aim of the current study was to compare the long-term outcomes of patients who underwent D1 distal pancreatectomy (DP) with D2 DP for left-sided PDAC. Patients and Methods: Patients undergoing DP for left-sided PDAC at the four institutions affiliated to The Jikei University were enrolled in this study. Patients were divided into D1 and D2 groups. Patients' clinical characteristics, overall survival (OS), and relapse -free survival (RFS) were compared between the two groups before and after propensity-score matched (PSM) analysis. Results: Of 145 patients with left-sided PDAC, 55 patients underwent D1 DP and 90 underwent D2 DP, of whom 38 matched pairs were included in the PSM analytic cohort. In the unmatched cohort, no significant difference was found between the D1 and D2 groups for both OS (median 2.51 vs. 3.07 years; p=0.709) and RFS (median 1.47 vs. 1.27 years; p=0.565). After PSM, OS (median 2.37 vs. 3.56 years; p=0.407) and RFS (median 1.35 vs. 1.11 years; p=0.542) were not significantly different between the two groups. In a comparison of regional and systemic recurrence sites, no significant difference was observed between the two groups ( p=0.500). Conclusion: The long-term survival of D1 DP for left-sided PDAC was not inferior to D2 DP. In an era in which the importance of multidisciplinary treatment for PDAC has been documented, unnecessary extended surgery should be avoided.