Stitzenberg Karyn B, Watson James Christopher, Roberts Andrew, Kagan Steven A, Cohen Steven J, Konski Andre A, Hoffman John P
Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
Ann Surg Oncol. 2008 May;15(5):1399-406. doi: 10.1245/s10434-008-9844-y. Epub 2008 Mar 5.
Absence of major arterial tumor involvement has generally been regarded as a major criterion for resectability of pancreatic tumors. We hypothesize that resection of a tumor-involved hepatic artery (HA) or celiac artery (CA) with reconstruction may offer a survival benefit to patients whose tumors were traditionally regarded as unresectable.
All patients with pancreatic adenocarcinoma treated between 1996 and 2007 were reviewed. Patients were included if they underwent resection of the HA or CA during pancreatectomy. Survival was analyzed by Kaplan-Meier survivor functions, Cox proportional hazard models, and the log rank test.
Twelve patients (six men and six women) with adenocarcinoma underwent pancreatectomy with resection of a tumor-involved HA (n = 2) and/or CA (n = 10). Median age at diagnosis was 62 years (range, 53-73 years). All patients completed neoadjuvant chemoradiotherapy with or without full dose chemotherapy before resection. Procedures performed were six extended pancreaticoduodenectomies, two proximal subtotal pancreatectomies, two distal pancreatectomies, and two total pancreatectomies. Ten cases involved celiac resections, and two had isolated HA resections. The 60-day mortality was 17% (2 of 12). Median survival after diagnosis was 20 months (range, 6-41 months). Median survival after resection was 17 months (range, 1-36 months). Survival was not statistically significantly related to age, sex, margin status, or preoperative CA19-9 level. The 3-year survival was 17%. There were no 5-year survivors.
Resection of the HA or CA with reconstruction may prolong survival for selected patients who undergo pancreatic resection after neoadjuvant therapy. However, this aggressive approach did not result in any long-term survivors in our series.
主要动脉未受肿瘤累及通常被视为胰腺肿瘤可切除性的主要标准。我们推测，对受肿瘤累及的肝动脉（HA）或腹腔干动脉（CA）进行切除并重建，可能会给那些传统上被认为无法切除肿瘤的患者带来生存益处。
回顾了1996年至2007年间接受治疗的所有胰腺腺癌患者。如果患者在胰腺切除术中接受了HA或CA切除，则纳入研究。通过Kaplan-Meier生存函数、Cox比例风险模型和对数秩检验分析生存率。
12例（6男6女）腺癌患者接受了胰腺切除术，其中2例切除了受肿瘤累及的HA，10例切除了受肿瘤累及的CA。诊断时的中位年龄为62岁（范围53 - 73岁）。所有患者在切除术前均完成了新辅助放化疗，部分患者还接受了全剂量化疗。实施的手术包括6例扩大胰十二指肠切除术、2例近端胰腺次全切除术、2例远端胰腺切除术和2例全胰腺切除术。10例涉及腹腔干切除术，2例仅行HA切除术。60天死亡率为17%（12例中的2例）。诊断后的中位生存期为20个月（范围6 - 41个月）。切除术后的中位生存期为17个月（范围1 - 36个月）。生存率与年龄、性别、切缘状态或术前CA19-9水平无统计学显著相关性。3年生存率为17%。无5年生存者。
对HA或CA进行切除并重建可能会延长新辅助治疗后接受胰腺切除术的部分患者的生存期。然而，在我们的系列研究中，这种积极的方法并未产生任何长期生存者。
