Ishikawa Osamu, Wada Hiroshi, Ohigashi Hiroaki, Doki Yuichiro, Yokoyama Shigekazu, Noura Shingo, Yamada Terumasa, Sasaki Yo, Imaoka Shingi, Kasugai Tsutomu, Matsunaga Takashi, Takenaka Akemi, Nakaizumi Akihiko
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-Nakamichi, 1-chome, Higashinari-ku, Osaka 537-8511, Japan.
Ann Surg. 2003 Jul;238(1):103-10. doi: 10.1097/01.SLA.0000074982.51763.d6.
To evaluate the postoperative cytology of drained fluid from the pancreatic bed as a predictive indicator of local recurrence after curative (R0) resection of pancreatic cancer.
The pancreatic bed offers a common site of cancer recurrence (local recurrence), even after curative (R0) resection is performed for pancreatic cancer. If local recurrence is thereby predicted precisely, soon after surgery, we have a chance to treat it by adding radiation or some other locoregional therapy before it can grow or spread beyond the pancreatic bed. However, there have been no previous reports of cytology performed on the drained fluid after pancreatectomy.
This study includes 94 patients who had shown negative results in the peritoneal washing cytology before resection and subsequently received pancreatectomies for pancreatic tumors. They consisted of 12 benign tumors, 17 noninvasive or minimally invasive carcinomas and 65 invasive ductal carcinomas (R0 = 58; R1/2 = 7). Postoperatively, the drained fluid from the pancreatic bed was collected for 24 hours and used for cytologic examination. The cytologic results were examined in association with the histopathology of the resected tumor, patient's survival, and mode of cancer recurrence, including local recurrence.
Patients with benign tumors or noninvasive/minimally invasive carcinomas had negative result in cytology, and none of them have died of local recurrence (limited to the pancreatic bed) to date. However, patients with invasive ductal carcinoma revealed higher cytology-positive rates: 28% (16/58) in curative (R0) resection; and 71% (5/7) in noncurative (R1/2) resection. Among 58 patients with R0 resection, the 3-year survival rate was 14% in 16 cytology-positive patients and 55% in 42 cytology-negative patients (P < 0.05). The 3-year cumulative rate of local recurrence was 85% and 23%, respectively (P < 0.05). Compared with other histopathologic parameters obtained from the resected specimens, the drain cytology was more specific in predicting the subsequent development of local recurrence.
Drain-cytology was a quick examination that enabled us to specifically indicate both minute residual cancer and subsequent development of local recurrence even after R0 resection of pancreatic cancer.
评估胰腺癌根治性（R0）切除术后胰床引流液的细胞学检查结果作为局部复发预测指标的价值。
即使对胰腺癌进行了根治性（R0）切除，胰床仍是癌症复发（局部复发）的常见部位。如果能在术后早期准确预测局部复发，我们就有机会在肿瘤生长或扩散至胰床以外之前，通过增加放疗或其他局部区域治疗来进行处理。然而，此前尚无关于胰腺切除术后引流液细胞学检查的报道。
本研究纳入94例患者，这些患者在切除术前的腹腔冲洗细胞学检查结果为阴性，随后接受了胰腺肿瘤切除术。其中包括12例良性肿瘤、17例非侵袭性或微侵袭性癌以及65例侵袭性导管癌（R0 = 58例；R1/2 = 7例）。术后，收集胰床引流液24小时用于细胞学检查。将细胞学检查结果与切除肿瘤的组织病理学、患者生存率以及癌症复发模式（包括局部复发）进行关联分析。
良性肿瘤或非侵袭性/微侵袭性癌患者的细胞学检查结果为阴性，且迄今为止均未死于局部复发（局限于胰床）。然而，侵袭性导管癌患者的细胞学阳性率较高：根治性（R0）切除患者中为28%（16/58）；非根治性（R1/2）切除患者中为71%（5/7）。在58例R0切除患者中，16例细胞学阳性患者的3年生存率为14%，42例细胞学阴性患者的3年生存率为55%（P < 0.05）。局部复发的3年累积发生率分别为85%和23%（P < 0.05）。与从切除标本获得的其他组织病理学参数相比，引流液细胞学检查在预测局部复发的后续发展方面更具特异性。
引流液细胞学检查是一种快速检查方法，即使在胰腺癌R0切除术后，也能使我们特异性地指出微小残留癌以及局部复发的后续发展情况。
