Hishinuma Shoichi, Ogata Yoshiro, Tomikawa Moriaki, Ozawa Iwao, Hirabayashi Kaoru, Igarashi Seiji
Department of Surgery, Tochigi Cancer Center, Tochigi, Japan.
J Gastrointest Surg. 2006 Apr;10(4):511-8. doi: 10.1016/j.gassur.2005.09.016.
The autopsy findings of patients who died of recurrence after curative resection of pancreatic cancer may afford a reliable guide to increase long-term survival after surgery. Recurrence patterns were analyzed for 27 autopsied patients who had undergone potentially curative resection of pancreatic cancer. The pattern of recurrence was classified as follows: (1) local recurrence, (2) hepatic metastasis, (3) peritoneal dissemination, (4) para-aortic lymph node metastasis, and (5) distant metastasis not including hepatic metastasis, peritoneal dissemination, and para-aortic lymph node metastasis. Of the 27 autopsied patients, recurrence was confirmed for 22 of 24 patients, except for three who died of early postoperative complications. Eighteen (75%) of the 24 patients had local recurrence, 12 (50%) had hepatic metastasis, and 11 (46%) had both. For four patients, local recurrence confirmed by autopsy was undetectable by computed tomography, because the recurrent lesions had infiltrated without forming a tumor mass. Peritoneal dissemination, para-aortic lymph node metastasis, and distant metastasis were found for eight (33%), five (21%), and 18 (75%) of the cases, respectively. Twenty patients died of cancer, but local recurrence was judged to be the direct cause of death of only four. Local recurrence frequently occurs, but is rarely a direct cause of death, and most patients died of metastatic disease. Therefore, treatment that focuses on local control cannot improve the survival of patients with resectable pancreatic cancer, and thus, treatment regimens that are effective against systemic metastasis are needed.
胰腺癌根治性切除术后死于复发患者的尸检结果可能为提高术后长期生存率提供可靠指导。对27例行胰腺癌潜在根治性切除的尸检患者的复发模式进行了分析。复发模式分类如下：(1)局部复发；(2)肝转移；(3)腹膜播散；(4)主动脉旁淋巴结转移；(5)不包括肝转移、腹膜播散和主动脉旁淋巴结转移的远处转移。在这27例尸检患者中，24例患者中有22例证实复发，3例死于术后早期并发症。24例患者中有18例(75%)发生局部复发，12例(50%)发生肝转移，11例(46%)两者均有。4例患者经尸检证实的局部复发在计算机断层扫描中未被发现，因为复发灶呈浸润性生长而未形成肿瘤肿块。腹膜播散、主动脉旁淋巴结转移和远处转移分别在8例(33%)、5例(21%)和18例(75%)病例中发现。20例患者死于癌症，但仅4例患者的直接死因被判定为局部复发。局部复发经常发生，但很少是直接死因，大多数患者死于转移性疾病。因此，专注于局部控制的治疗不能提高可切除胰腺癌患者的生存率，因此，需要有效的抗全身转移治疗方案。
