Pingpank James F, Hoffman John P, Sigurdson Elin R, Ross Eric, Sasson Aaron R, Eisenberg Burton L
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
Am Surg. 2002 Apr;68(4):337-40; discussion 340-1.
We conducted a retrospective review of our single-institution experience with pancreas resection for locally advanced primary malignancy or metastases from other organs. From January 1989 through April 2001 35 patients underwent pancreatic resection for locally advanced primary (17) and recurrent nonpancreatic (18) tumors. Patient records were examined for recurrence and survival. Seventeen patients with locally advanced primary tumors presented with pancreatic extension either into the head/body (six) or tail (11). Pancreatic resections were completed as en bloc procedures with the primary disease of stomach (five), colon (four), sarcoma (five), adrenal gland (one), or spleen (one). Procedures performed included pancreaticoduodenectomy for proximal lesions and distal pancreatectomy for disease limited to the pancreatic tail. Median overall survival was 56 months. Fourteen of 17 patients remain alive: three with disease and 11 without evidence of recurrence. Eighteen patients presented with recurrent tumor from a previously resected right upper quadrant tumor (nine) or metastases from an intra-abdominal source (nine). The primary source was colon (eight), biliary (three), sarcoma (three), melanoma (two), ovary (one), and unknown primary (one). Patients underwent pancreaticoduodenectomy, distal pancreatectomy, or resection of residual pancreas. Overall median survival was 46 months. In this group of 18 patients there was no increased survival in those patients with a time to recurrence from their primary tumor resection greater than 2 years. We conclude that pancreatic resection for locally advanced nonpancreatic or recurrent intra-abdominal malignancies is possible in properly selected patients. The ability to obtain disease-free margins through en bloc resection is a key component of therapy.
我们对本机构针对局部晚期原发性恶性肿瘤或其他器官转移瘤进行胰腺切除术的经验进行了回顾性研究。从1989年1月至2001年4月，35例患者因局部晚期原发性肿瘤（17例）和复发性非胰腺肿瘤（18例）接受了胰腺切除术。检查患者记录以了解复发情况和生存率。17例局部晚期原发性肿瘤患者表现为胰腺向头部/体部（6例）或尾部（11例）扩展。胰腺切除术作为整块手术完成，原发疾病包括胃癌（5例）、结肠癌（4例）、肉瘤（5例）、肾上腺肿瘤（1例）或脾脏肿瘤（1例）。所实施的手术包括针对近端病变的胰十二指肠切除术和针对局限于胰尾的疾病的远端胰腺切除术。总体中位生存期为56个月。17例患者中有14例仍存活：3例有疾病，11例无复发迹象。18例患者表现为先前切除的右上腹肿瘤复发（9例）或来自腹腔内来源的转移瘤（9例）。原发部位为结肠癌（8例）、胆管癌（3例）、肉瘤（3例）、黑色素瘤（2例）、卵巢癌（1例）和原发灶不明（1例）。患者接受了胰十二指肠切除术、远端胰腺切除术或残余胰腺切除术。总体中位生存期为46个月。在这组18例患者中，那些从原发性肿瘤切除到复发时间超过2年的患者生存率并未提高。我们得出结论，在经过适当选择的患者中，针对局部晚期非胰腺或复发性腹腔内恶性肿瘤进行胰腺切除术是可行的。通过整块切除获得无瘤切缘的能力是治疗的关键组成部分。
