Amano Hodaka, Miura Fumihiko, Toyota Naoyuki, Wada Keita, Katoh Ken-ichirou, Hayano Kouichi, Kadowaki Susumu, Shibuya Makoto, Maeno Sawako, Eguchi Tomoaki, Takada Tadahiro, Asano Takehide
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga-cho, Itabashi-ku, Tokyo 173-8605, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(6):850-7. doi: 10.1007/s00534-009-0190-7.
BACKGROUND/PURPOSE: We often encounter unresectable pancreatic cancer due to invasions of the major vessels. Vascular resection for locally advanced pancreatic cancers has an advantage in en block local resection. There are potential cases in which good outcomes can be achieved by arterial resection.
Pancreatectomy (including total pancreatectomy in 15 cases, pancreatoduodenectomy in 7 cases and distal pancreatectomy in one case) was performed in 23 cases of invasive ductal carcinoma of the pancreas, in combination with resection and reconstruction of the hepatic artery in 15 cases, the superior mesenteric artery in 12 cases (there are overlaps) and the portal vein in 20 cases.
The median operating time was 686 min (416-1,190 min) and the median blood loss was 2,830 ml (440-19,800 ml). This shows that the surgery was highly-invasive. The operative mortality rate was 4.3%. On the basis of the UICC classification, there were 2 cases of Stage IIa, 4 cases of Stage IIb, 9 cases of Stage III, 8 cases of Stage IV, while there were 18 cases (78.3%) of R0 resection. On the other hand, the final histological findings showed that there were 8 cases (34.8%) of M1 (liver and non-regional lymph node metastases), so it is thought that decisions on operative indications should be not be made slightly. As for the overall survival rate, the 1-year survival rate was 51.2% and the 3-year survival rate was 23.1% while the median survival time (MST) was 12 months. As for 15 cases of M0, the 1-year survival rate was 61.9% and the 4-year survival rate was 38.7% while the MST was 16 months. On the other hand, the MST was poor (10 months) in 8 cases of M1, showing that a statistically significant difference was observed depending upon the degree of metastasis (log-rank P = 0.0409). In 18 cases of R0, the 1-year survival rate was 67.2%, the 4-year survival rate 30.2% and the MST 13 months, respectively, while in 5 cases of R1 and R2, the MST was 6 months, showing that there was a statistically significant difference between R0 cases and R1, R2 cases (log-rank P = 0.0002).
Further discussion is required concerning surgical indications and significance. However, it is thought that resection is useful only when surgery of R0 has taken place for selected locally advanced pancreatic cancer (M0).
背景/目的：我们经常会遇到因主要血管受侵而无法切除的胰腺癌。对于局部进展期胰腺癌进行血管切除，在整块局部切除方面具有优势。存在一些通过动脉切除可取得良好效果的潜在病例。
对23例胰腺浸润性导管癌患者实施了胰腺切除术（包括15例全胰切除术、7例胰十二指肠切除术和1例胰体尾切除术），其中15例联合肝动脉切除与重建，12例联合肠系膜上动脉切除（存在重叠情况），20例联合门静脉切除。
中位手术时间为686分钟（416 - 1190分钟），中位失血量为2830毫升（440 - 19800毫升）。这表明该手术具有高度侵袭性。手术死亡率为4.3%。根据国际抗癌联盟（UICC）分类，Ⅱa期2例，Ⅱb期4例，Ⅲ期9例，Ⅳ期8例，R0切除18例（78.3%）。另一方面，最终组织学检查结果显示，有8例（34.8%）为M1（肝和非区域淋巴结转移），因此认为手术适应证的决策不应草率。关于总生存率，1年生存率为51.2%，3年生存率为23.1%，中位生存时间（MST）为12个月。对于15例M0患者，1年生存率为61.9%，4年生存率为38.7%，MST为16个月。另一方面，8例M1患者的MST较差（10个月），这表明根据转移程度观察到有统计学显著差异（对数秩检验P = 0.0409）。在18例R0患者中，1年生存率分别为67.2%，4年生存率为30.2%，MST为13个月，而在5例R1和R2患者中，MST为6个月，这表明R0患者与R1、R2患者之间存在统计学显著差异（对数秩检验P = 0.0002）。
关于手术适应证和意义仍需进一步讨论。然而，仅当对选定的局部进展期胰腺癌（M0）进行R0手术时，切除才被认为是有用的。
