Abramson Michael A, Swanson Edward W, Whang Edward E
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
J Gastrointest Surg. 2009 Jan;13(1):26-34. doi: 10.1007/s11605-008-0648-y. Epub 2008 Oct 23.
Benefit from pancreaticoduodenectomy (PD) combined with superior mesenteric-portal vein (SMV-PV) resection in the management of pancreatic adenocarcinoma with local venous invasion remains controversial.
Using formal decision analysis, we compared survival associated with PD plus SMV-PV resection when applied to patients with pancreatic adenocarcinoma with isolated local venous invasion (Group 1) versus that achieved with palliative chemoradiotherapy when applied to patients with locally advanced pancreatic cancer (Group 2). Individual studies were identified using Medline. A total of 1,324 and 709 patients were analyzed for Groups 1 and 2, respectively. Patients with distant metastases were excluded.
Overall decision analysis favored surgical resection (Group 1) over palliative chemoradiotherapy (Group 2). Sensitivity analyses indicated that this decision is sensitive to the perioperative mortality rate and the percentage of surgical resections with microscopic (R1) or macroscopic (R2) residual tumor at the resection margin. In contrast, sensitivity analysis revealed that the decision is not sensitive to the percentage of cases in which true venous invasion by cancer is documented histologically.
Surgical resection may confer a survival advantage over palliative chemoradiotherapy in select patients with pancreatic cancers with presumed local venous invasion.
在伴有局部静脉侵犯的胰腺腺癌治疗中，胰十二指肠切除术（PD）联合肠系膜上静脉-门静脉（SMV-PV）切除是否有益仍存在争议。
采用正式决策分析，我们比较了对孤立性局部静脉侵犯的胰腺腺癌患者（第1组）应用PD加SMV-PV切除与对局部晚期胰腺癌患者（第2组）应用姑息性放化疗的生存情况。通过医学文献数据库检索确定个体研究。分别对第1组的1324例患者和第2组的709例患者进行分析。排除有远处转移的患者。
总体决策分析显示，手术切除（第1组）优于姑息性放化疗（第2组）。敏感性分析表明，该决策对围手术期死亡率以及切除边缘有镜下（R1）或肉眼（R2）残留肿瘤的手术切除百分比敏感。相比之下，敏感性分析显示该决策对组织学证实为真正癌性静脉侵犯的病例百分比不敏感。
对于某些推测有局部静脉侵犯的胰腺癌患者，手术切除可能比姑息性放化疗具有生存优势。
