Surgery for recurrent pancreatic ductal adenocarcinoma
Surgery for recurrent pancreatic ductal adenocarcinoma
复制标题
DOI：
10.1097/01.sla.0000245845.06772.7d
复制
发表时间：
2007-04-01
影响因子：
9
通讯作者：
Buechler, Markus W.
中科院分区：
文献类型：
--
作者：
Kleeff, Joerg;Reiser, Carolin;Buechler, Markus W.
目的：本研究评估胰腺癌复发手术患者的预后。背景资料：在潜在治愈性切除后2年内，高达80%的胰腺癌患者会发生胰腺导管腺癌复发，因为在大多数病例中，初次切除时存在隐匿性（局部和/或远处）微转移。方法：对2001年10月~ 2005年4月30例复发胰腺癌患者进行手术治疗。从初次切除到复发的中位时间为12.0个月。15例患者切除，15例患者接受姑息性旁路治疗或仅探查。回顾性分析前瞻性记录的资料。生存分析采用Kaplan-Meier估计和log-rank检验。结果：复发患者的总中位生存期为29.0个月。第一次切除/探查复发疾病后，中位生存期为11.4个月。与旁路探查组（9.4个月）相比，切除组（17.0个月）的中位生存期有增加的趋势，但差异无统计学意义（P = 0.084）。此外，与9个月内复发的患者相比，从切除到复发的时间间隔较长的患者更有可能从切除中获益（中位生存期17.0 vs. 7.4个月；P = 0.004）。切除患者的住院发病率和死亡率分别为20%和6.7%，而仅行探查/姑息性旁路治疗的患者的住院发病率和死亡率分别为13.3%和0%。结论：复发性胰腺癌手术切除是安全的。需要进一步的研究来解决这个问题，即亚组患者是否真的可以从这种手术中受益。
Objective: This study evaluates the outcome of patients who underwent surgery for recurrent pancreatic cancer.Summary Background Data: Recurrence of pancreatic ductal adenocarcinoma occurs in up to 80% of pancreatic cancer patients within 2 years of a potential curative resection because, in most cases, occult (local and/or distant) micrometastases are present at the time of the initial resection.Methods: Thirty patients were operated for recurrent pancreatic cancer between October 2001 and April 2005. Median time between the initial resection and recurrence was 12.0 months. While 15 patients were resected, 15 patients either underwent palliative bypass or only exploration. Prospectively recorded data were analyzed retrospectively. Survival analysis was performed using Kaplan-Meier estimation and log-rank test.Results: The overall median survival of patients with recurrent disease was 29.0 months. After the first reresection/exploration for recurrent disease, the median survival was 11.4 months. There was a tendency of increased median survival in the group of patients undergoing resection (17.0 months) compared with the bypass/exploration group (9.4 months), although this difference was not significant (P = 0.084). In addition, patients with a prolonged interval (>9 months) from resection to recurrence were more likely to benefit from reresection compared with patients with recurrence within 9 months (median survival 17.0 vs. 7.4 months; P = 0.004). The in-hospital morbidity and mortality rate of resected patients was 20% and 6.7% compared with 13.3% and 0% of patients who underwent only exploration/palliative bypass.Conclusion: Resection for recurrent pancreatic cancer can be carried out safely. Further studies are required to address the question whether a subgroup of patients might actually benefit from this procedure.