Long-Term Results of Resection of Adenocarcinoma of the Body and Tail of the Pancreas Using Radical Antegrade Modular Pancreatosplenectomy Procedure
Long-Term Results of Resection of Adenocarcinoma of the Body and Tail of the Pancreas Using Radical Antegrade Modular Pancreatosplenectomy Procedure
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DOI：
10.1016/j.jamcollsurg.2011.10.008
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发表时间：
2012-01-01
影响因子：
5.2
通讯作者：
Strasberg, Steven M.
中科院分区：
文献类型：
--
作者：
Mitchem, Jonathan B.;Hamilton, Nicholas;Strasberg, Steven M.
背景：根治性顺行模块化胰脾切除术（RAMPS）是对标准远端胰脾切除术的改进。它的设计目的是为胰脏头部癌和胰脏尾部癌提供手术方法，特别是在淋巴结清扫的程度和强调获得显微镜下阴性切向边缘方面。本报告的目的是提供长期生存结果。研究设计：1999年至2008年间，47名患者出现了斜坡性斜坡。决定进行前路还是后路RAMPS是基于术前计算机断层扫描评估的肿瘤位置。患者被输入前瞻性数据库，并每隔一段时间进行随访。结果：32例患者有前斜坡斜坡，15例有后斜坡斜坡。除左肾上腺外，24例患者切除了33个器官。标本是在手术室里做的。平均肿瘤大小为4.4 cm。89%的标本切线边缘为负。总体而言，R0率为81%。平均淋巴结数18个。没有30天内死亡或住院死亡。在世患者的平均随访时间为44.4个月，中位随访时间为26.4个月。中位生存期为26个月，5年总精算生存率为35.5%。分析前手术时间超过5年的23例患者的实际生存率为30.4%。结论：RAMPS与这种侵袭性肿瘤的高切缘阴性率和非常令人满意的生存率相关。[J]中华医学杂志，2012;21(4):559 - 561。(C) 2012年由美国外科医师学会发布)
BACKGROUND: The radical antegrade modular pancreatosplenectomy (RAMPS) procedure is a modification of standard distal pancreatosplenectomy. It was designed to provide the operative approach developed for cancers of the head of the pancreas to cancers of the body and tail of the pancreas, particularly with respect to the extent of node dissection and emphasis on obtaining microscopically negative tangential margins. The purpose of this report is to provide long-term survival results.STUDY DESIGN: Forty-seven patients had RAMPS between 1999 and 2008. The decision to perform anterior vs posterior RAMPS was based on the position of the tumor as assessed by preoperative computed tomograms. Patients were entered in a prospective database and followed at intervals.RESULTS: Thirty-two patients had anterior RAMPS and 15 had posterior RAMPS. Twenty-four patients had resection of 33 organs in addition to the left adrenal gland in the posterior RAMPS. Specimens were inked in the operating room. Mean tumor size was 4.4 cm. Negative tangential margins were obtained in 89% of specimens. Overall, the R0 rate was 81%. Mean lymph node count was 18. There were no 30-day or in-hospital mortalities. Mean and median follow-up times of living patients were 44.4 and 26.4 months. Median survival was 26 months and 5-year overall actuarial survival was 35.5%. The actual survival of 23 patients whose surgery was performed more than 5 years before the time of analysis was 30.4%.CONCLUSIONS: RAMPS is associated with high negative tangential margin rates and very satisfactory survival rates for this aggressive tumor. (J Am Coll Surg 2012; 214: 46-52. (C) 2012 by the American College of Surgeons)