Extended resection in pancreatic metastases: feasibility, frequency, and long-term outcome: a retrospective analysis.
Extended resection in pancreatic metastases: feasibility, frequency, and long-term outcome: a retrospective analysis.
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DOI：
10.1186/s12893-015-0114-1
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发表时间：
2015-12-11
期刊：
影响因子：
1.9
通讯作者：
Bartels M
中科院分区：
文献类型：
--
作者：
Wiltberger G;Bucher JN;Krenzien F;Benzing C;Atanasov G;Schmelzle M;Hau HM;Bartels M
转移到胰腺是罕见的，占不到2%的所有胰腺恶性肿瘤。然而，扩大肿瘤切除术的益处和理想的肿瘤学方法尚未确定，因此，我们评估了胰腺转移患者接受胰腺切除术。在1994年至2012年期间，676例患者在我们机构接受了胰腺手术。我们根据生存率、手术和非手术并发症回顾性分析了患者的医疗记录。使用Student t检验和对数秩检验进行统计分析。18例患者（2.7%）接受胰腺转移瘤切除术（12例多脏器切除术和6例标准切除术）。胰腺转移瘤来源于肾细胞癌（n = 10）、恶性黑色素瘤（n = 2）、回肠神经内分泌肿瘤（n = 1）、肉瘤（n = 1）、结肠癌（n = 1）、胆囊癌（n = 1）、胃肠道间质瘤（n = 1）和非小细胞肺癌（n = 1）。从原发性恶性肿瘤切除到膀胱切除的中位时间为83个月（范围，0-228个月）。6例患者（33.3%）发生轻微手术并发症（I-IIIa级），3例患者（16.6%）发生严重手术并发症（IIIb-V级）。无患者在住院期间死亡。中位随访时间为76个月（范围：10-165个月）。标准切除术与多脏器切除术的1年、3年和5年生存率分别为83%、50%和56%，而标准切除术与多脏器切除术的1年、3年和5年生存率分别为83%、66%和50%。12名患者在中位26个月（范围，5-55个月）后死亡。在选择胰腺转移患者时，以根治为目的的手术方法是合理的，并提供良好的长期生存率。与原发性胰腺恶性肿瘤切除术相比，切除不同类型肿瘤的胰腺转移瘤具有较好的发病率和死亡率。我们的研究结果还表明，多脏器切除术是可行的，具有可接受的长期结果，即使多脏器切除术后的发病率往往高于标准切除术后。
Metastases to the pancreas are rare, accounting for less then 2 % of all pancreatic malignancies. However, both the benefit of extended tumor resection and the ideal oncological approach have not been established for such cases; therefore, we evaluated patients with metastasis to the pancreas who underwent pancreatic resection. Between 1994 and 2012, 676 patients underwent pancreatic surgery in our institution. We retrospectively reviewed patients’ medical records according to survival, and surgical and non-surgical complications. Student’s t-test and the log-rank test were used for statistical analysis. Eighteen patients (2.7 %) received resection for pancreatic metastases (12 multivisceral resections and 6 standard resections). The pancreatic metastases originated from renal cell carcinoma (n = 10), malignant melanoma (n = 2), neuroendocrine tumor of the ileum (n = 1), sarcoma (n = 1), colon cancer (n = 1), gallbladder cancer (n = 1), gastrointestinal stromal tumor (n = 1), and non-small cell lung cancer (n = 1). The median time between primary malignancy resection to metastasectomy was 83 months (range, 0–228 months). Minor surgical complications (Grade I-IIIa) occurred in six patients (33.3 %) whereas major surgical complications (Grade IIIb-V) occurred in three patients (16.6 %). No patients died during hospitalization. The median follow-up was 76 months (range, 10–165 months). One-year, 3-year and 5-year survival for standard resection versus multivisceral resection was 83, 50, and 56 % versus 83, 66, and 50, respectively. Twelve patients died after a median of 26 months (range, 5–55 months). A surgical approach with curative intent is justified in select patients suffering from metastases to the pancreas and offers good long-term survival. The resection of pancreatic metastases of different tumor types was associated with favorable morbidity and mortality when compared with resection of the primary pancreatic malignancies. Our findings also demonstrated that multivisceral resection was feasible, with acceptable long term outcomes, even though morbidity rates tended to be higher after multivisceral resection than after standard resection.