Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas
Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas
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DOI：
10.1016/j.gassur.2005.04.008
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发表时间：
2005-09-01
影响因子：
3.2
通讯作者：
Farnell, MB
中科院分区：
文献类型：
--
作者：
Christein, JD;Kendrick, ML;Farnell, MB
本研究的目的是分析胰腺远端切除术治疗三种亚型腺癌的结果，以确定整体切除术在外科治疗中的作用。第二个目的是在仅限于导管腺癌的分析中确定与生存相关的临床病理因素。我们回顾了1987年至2003年间连续接受远端胰腺癌切除术的患者的病历。对接受标准和整块切除术的患者的安全性和结局进行了比较分析。对导管腺癌患者行远端胰腺切除术的临床病理因素进行单变量和多变量生存分析。93例患者因导管腺癌（66，71%）、粘液性囊腺癌（18，19%）或导管内乳头状粘液性肿瘤（IPMN）相关腺癌（9，10%）接受了切除术。33例（35%）患者需要整块切除。无手术死亡。导管腺癌、粘液性囊腺癌和IPMN相关腺癌的中位生存期分别为15.5个月、30.2个月和50.7个月。接受整块切除术的患者总体并发症发生率更高，需要更多的输血和更多的重症监护病房入院，并且有更高的阳性切缘率;然而，没有死亡。对于导管腺癌，肿瘤大小大于3.5 cm、年龄大于60岁和分期是单变量分析中与生存相关的因素。在多变量分析中无显著性差异。4例导管腺癌患者实际存活5年。虽然整块切除术的并发症发生率较高，但大多数是自限性的，死亡率较低。适当时应进行切除，包括邻近器官。可以预期囊腺癌或IPMN相关腺癌患者的长期生存率。虽然罕见，但胰腺远端切除术后导管腺癌患者的长期生存是可以实现的。
The study goal was to analyze outcome after distal pancreatectomy for three subtypes of adenocarcinoma to determine the role of en bloc resection in surgical management. A secondary aim was to identify those clinicopathologic factors correlating with survival in an analysis limited to ductal adenocarcinoma. Medical records of consecutive patients undergoing distal pancreatectomy for adenocarcinoma between 1987 and 2003 were reviewed. A comparative analysis was undertaken of the safety and outcome of patients undergoing standard and en bloc resections. Clinicopathologic factors for patients undergoing distal pancreatectomy for ductal adenocarcinoma were subjected to both univariate and multivariate survival analyses. Ninety-three patients underwent resection for ductal adenocarcinoma (66, 71%), mucinous cystadenocarcinoma (18, 19%), or adenocarcinoma associated with intraductal papillary mucinous neoplasm (IPMN) (9, 10%). En bloc resection was required in 33 (35%) patients. There was no operative mortality. Median survival was 15.5 months, 30.2 months, and 50.7 months for ductal adenocarcinoma, mucinous cystadenocarcinoma, and adenocarcinoma associated with IPMN, respectively. Patients undergoing en bloc resection had a higher overall complication rate, required more transfusions and more intensive care unit admissions, and had a higher rate of positive margins; however, there were no deaths. For ductal adenocarcinoma, tumor size greater than 3.5 cm, age greater than 60 years, and stage were factors that correlated with survival on a univariate analysis. None were significant on multivariate analysis. Four patients with ductal adenocarcinoma were actual 5-year survivors. While en bloc resections are associated with a higher rate of complications, the majority are self-limited and mortality is low. Resection, including adjacent organs, should be performed when appropriate. Long-term survival for patients with cystadenocarcinoma or IPMN-associated adenocarcinoma can be anticipated. While rare, long-term survival for patients with ductal adenocarcinoma after distal pancreatectomy can be achieved.