Nationwide Outcome of Gastrectomy with En-Bloc Partial Pancreatectomy for Gastric Cancer
Nationwide Outcome of Gastrectomy with En-Bloc Partial Pancreatectomy for Gastric Cancer
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DOI：
10.1007/s11605-019-04133-z
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发表时间：
2019-12-01
影响因子：
3.2
通讯作者：
Tetteroo, G. W. M.
中科院分区：
文献类型：
--
作者：
van der Werf, L. R.;Eshuis, W. J.;Tetteroo, G. W. M.
背景：根治性胃切除术是胃癌治疗的基石。对于侵犯胰腺的肿瘤，可能需要整块胰腺部分切除以进行根治性切除。本研究的目的是评价胃切除联合胰腺部分切除治疗胃癌的疗效。方法从荷兰上消化道癌症评估(DUCA)中选择2011-2015年间因胃或胃食道交界处癌症而行胃切除加或不加胰腺部分切除的患者。结果是手术切缘(Pr0)和Clavien-Dindo分级为III级的术后并发症和存活率。采用多因素Logistic回归分析胰腺部分切除术与术后并发症的关系。结果1966例胃切除患者中，55例(2.8%)行全组胰腺部分切除。55例患者中45例获得Pr0切除(82%比85%，P=0.82)。55例患者中有21例发生了Clavien-Dindo III级并发症(38%对17%，P<；0.001)。中位总生存期[95%可信区间]为15[6.8-23.2]个月。围手术期接受和不接受系统治疗的患者中位生存期分别为20[12.3~27.7]个月和10[5.7~14.3]个月，行Pr0和PR1切除的患者中位生存期分别为20[11.8~28.3]个月和5个[2.4~7.6]个月。只有在Pr0切除可行的情况下，才应进行手术。
Background Radical gastrectomy is the cornerstone of the treatment of gastric cancer. For tumors invading the pancreas, en-bloc partial pancreatectomy may be needed for a radical resection. The aim of this study was to evaluate the outcome of gastrectomies with partial pancreatectomy for gastric cancer.Methods Patients who underwent gastrectomy with or without partial pancreatectomy for gastric or gastro-oesophageal junction cancer between 2011 and 2015 were selected from the Dutch Upper GI Cancer Audit (DUCA). Outcomes were resection margin (pR0) and Clavien-Dindo grade >= III postoperative complications and survival. The association between partial pancreatectomy and postoperative complications was analyzed with multivariable logistic regression. Overall survival of patients with partial pancreatectomy was estimated using the Kaplan-Meier method.Results Of 1966 patients that underwent gastrectomy, 55 patients (2.8%) underwent en-bloc partial pancreatectomy. A pR0 resection was achieved in 45 of 55 patients (82% versus 85% in the group without additional resection, P = 0.82). Clavien-Dindo grade = III complications occurred in 21 of 55 patients (38% versus 17%, P < 0.001). Median overall survival [95% confidence interval] was 15 [6.8-23.2] months. For patients with and without perioperative systemic therapy, median survival was 20 [12.3-27.7] and 10 [5.7-14.3] months, and for patients with pR0 and pR1 resection, it was 20 [11.8-28.3] and 5 [2.4-7.6] months, respectively.Conclusions Gastrectomy with partial pancreatectomy is not only associated with a pR0 resection rate of 82% but also with increased postoperative morbidity. It should only be performed if a pR0 resection is feasible.