Impact of laparoscopic staging in the treatment of pancreatic cancer
Impact of laparoscopic staging in the treatment of pancreatic cancer
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DOI：
10.1001/archsurg.135.4.409
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发表时间：
2000-04-01
影响因子：
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通讯作者：
Fernandez-del Castillo, C
中科院分区：
文献类型：
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作者：
Jimenez, RE;Warshaw, AL;Fernandez-del Castillo, C
假设：分期腹腔镜检查胰腺癌患者确定意外的转移，允许治疗选择，并有助于预测survival.Design：初始cohol.Setting：三级转诊center.Patients：共125例连续患者与放射学阶段II至III胰腺导管腺癌谁进行分期腹腔镜检查与腹膜细胞学检查1994年7月至1998年11月。78例近端肿瘤和47例远端肿瘤被定位。干预措施：根据螺旋计算机断层扫描（CT）和腹腔镜检查的结果，患者被分为3组。第1组患者在腹腔镜检查时发现了未被怀疑的转移灶，但没有进一步手术。第2组患者没有明显的转移，但CT显示由于血管侵犯而不可切除。该组患者接受体外放射线照射和氟尿嘧啶化疗，然后在选定的病例中进行术中放疗。第3组中的患者没有转移或明确的血管浸润和切除candides.Results：分期腹腔镜检查发现39例（31.2%），9例有阳性细胞学检查结果的转移性疾病的唯一证据（组1）的可疑转移。55名患者（44.0%）患有局部但不可切除的癌（第2组），其中2名（3.6%）不能耐受治疗，20名（36.4%）在治疗期间发生转移性疾病，21名（38.2%）接受术中放疗。在31例可能切除肿瘤的患者中（第3组），23例进行了根治性切除（可切除率，74.2%）。转移性疾病患者的中位生存期为7.5个月，接受放化疗的患者为10.5个月，接受肿瘤切除术的患者为14.5个月（第2组与第1组的P = 0.01;第3组与第1组的P <0.001）。分期腹腔镜检查结合螺旋CT，允许将患者分为3个治疗组，与治疗机会和随后的生存率相关。在125例患者中，腹腔镜避免了39例不必要的手术和CT无法检测到的转移性疾病患者的放射治疗。腹腔镜分期可以帮助集中积极治疗胰腺癌患者谁可能受益。
Hypothesis: Staging laparoscopy in patients with pancreatic cancer identifies unsuspected metastases, allows treatment selection, and helps predict survival.Design: Inception cohort.Setting: Tertiary referral center.Patients: A total of 125 consecutive patients with radiographic stage II to III pancreatic ductal adenocarcinoma who underwent staging laparoscopy with peritoneal cytologic examination between July 1994 and November 1998. Seventy-eight proximal tumors and 47 distal rumors were localized.Interventions: Based on the findings of spiral computed tomography (CT) and laparoscopy, patients were stratified into 3 groups. Group 1 patients had unsuspected metastases found at laparoscopy and were palliated without further operation. Group 2 patients had no demonstrable metastases, but CT indicated unresectability due to vessel invasion. This group underwent external beam radiation with fluorouracil chemotherapy followed in selected cases by intraoperative radiation. Patients in group 3 had no metastases or definitive vessel invasion and were resection candidates.Results: Staging laparoscopy revealed unsuspected metastases in 39 patients (31.2%), with 9 having positive cytologic test results as the only evidence of metastatic disease (group 1). Fifty-five patients (44.0%) had localized but unresectable carcinoma (group 2), of whom 2 (3.6%) did not tolerate treatment, 20 (36.4%) developed metastatic disease during treatment, and 21 (38.2%) received intraoperative radiation. Of 31 patients with potentially resectable tumors (group 3), resection for cure was performed in 23 (resectability rate, 74.2%). Median survival was 7.5 months for patients with metastatic disease, 10.5 months for those receiving chemoradiation, and 14.5 months for those who underwent tumor resection (P = .01 for group 2 vs group 1; P < .001 for group 3 vs group 1).Conclusions: Staging laparoscopy, combined with spiral CT, allowed stratification of patients into 3 treatment groups that correlated with treatment opportunity and subsequent survival. Among the 125 patients, laparoscopy obviated 39 unnecessary operations and irradiation in patients with metastatic disease not detectable by CT. Laparoscopic staging can help focus aggressive treatment on patients with pancreatic cancer who might benefit.