Shrikhande Shailesh V, Kleeff Jörg, Reiser Carolin, Weitz Jürgen, Hinz Ulf, Esposito Irene, Schmidt Jan, Friess Helmut, Büchler Markus W
Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India.
Ann Surg Oncol. 2007 Jan;14(1):118-27. doi: 10.1245/s10434-006-9131-8. Epub 2006 Oct 25.
Improved safety of pancreatic surgery has led to consideration of more aggressive approaches, such as resection for primary pancreatic ductal adenocarcinoma (PDAC) with metastatic disease (M1).
A total of 29 patients who underwent pancreatic resection with resection of associated metastatic disease (interaortocaval lymph node dissection, liver resection, and/or multiorgan resections) were retrospectively identified from a database of 316 R0/R1 pancreatic resections for PDAC. An explorative data analysis of perioperative and clinicopathological parameters, and overall survival was performed by Kaplan-Meier estimation, log rank test, and Fisher's exact test.
The overall in-hospital mortality and morbidity of R0/R1 pancreatic resections for M1 disease (n = 29) was 0% and 24.1%, compared with 4.2% and 35.2% of R0/R1 pancreatic resections for M0 disease (n = 287). The median overall survival time was 13.8 months (95% confidence interval [CI], 11.4-20.5), and the estimated 1-year overall survival rate was 58.9% (95% CI, 34.8-76.7) for patients with M1 disease. The median survival in those with metastatic interaortocaval lymph nodes was 27 months (95% CI, 9.6-27.0), whereas it was 11.4 months (95% CI, 7.8-16.5) and 12.9 months (95% CI, 7.2-20.5) for those with liver and peritoneal metastases, respectively.
Pancreatic resections with M1 disease can be performed with acceptable safety in highly selected patients. The survival after interaortocaval lymph node resection is comparable to that of other lymph nodes that do not constitute M1 disease. Resection of liver and peritoneal metastases, although safe in this series, cannot be generally recommended until further controlled trials can be conducted.
胰腺手术安全性的提高促使人们考虑采用更积极的手术方法，例如对伴有转移性疾病（M1）的原发性胰腺导管腺癌（PDAC）进行切除。
从316例因PDAC行R0/R1胰腺切除术的数据库中，回顾性确定了29例行胰腺切除并切除相关转移性疾病（主动脉腔静脉间淋巴结清扫、肝切除和/或多器官切除）的患者。通过Kaplan-Meier估计、对数秩检验和Fisher精确检验对围手术期和临床病理参数以及总生存期进行探索性数据分析。
M1期疾病（n = 29）的R0/R1胰腺切除术的总体院内死亡率和发病率分别为0%和24.1%，而M0期疾病（n = 287）的R0/R1胰腺切除术的相应数据分别为4.2%和35.2%。M1期疾病患者的中位总生存时间为13.8个月（95%置信区间[CI]，11.4 - 20.5），估计1年总生存率为58.9%（95% CI，34.8 - 76.7）。主动脉腔静脉间淋巴结转移患者的中位生存期为27个月（95% CI，9.6 - 27.0），而肝转移和腹膜转移患者的中位生存期分别为11.4个月（95% CI，7.8 - 16.5）和12.9个月（95% CI，7.2 - 20.5）。
在经过严格挑选的患者中，对M1期疾病进行胰腺切除可获得可接受的安全性。主动脉腔静脉间淋巴结切除术后的生存率与其他不构成M1期疾病的淋巴结切除术后的生存率相当。肝转移和腹膜转移的切除，尽管在本系列研究中是安全的，但在能够进行进一步对照试验之前，一般不建议采用。
