Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Surg. 2010 Mar;251(3):483-7. doi: 10.1097/SLA.0b013e3181cf9171.
A retrospective study was performed to determine the prognostic implications of invasion to the splenic vessels in pancreatic body and tail cancer.
Involvement of the splenic artery (SA) and vein (SV) is frequently observed in carcinoma of the body and tail of the pancreas, but its correlation with various other clinicopathologic factors and prognosis has not been explored in detail.
Fifty-one patients who had undergone distal pancreatectomy for invasive adenocarcinoma of the body and tail of the pancreas were discreetly selected from the prospective data base for analyses. Cases that required extended surgery due to invasion of the major vessels such as the portal vein, common hepatic artery, celiac artery, and superior mesenteric artery were excluded. Correlation between invasion of the splenic vessels and prognosis and other clinicopathologic factors were analyzed.
Seventeen patients with invasion of the SA had a significantly inferior prognosis compared with those without the invasion (P = 0.0067), whereas invasion of the SV, observed in 24 patients, did not affect prognosis. Additionally, invasion of the SA significantly correlated with tumor size > or = 2 cm, anterior serosal infiltration, perineural invasion and SV invasion (P = 0.0440, P = 0.0406, P = 0.0460, and P = 0.0173, respectively). In univariate analysis, SA invasion, lymph node metastasis, and anterior serosal infiltration were identified as significant poor prognostic factors. In multivariable analysis, only SA invasion was an independent prognostic factor (odds ratio, 2.611, P = 0.0196).
Our results indicated that the invasion of the SA, but not that of the SV, is a crucial prognostic factor in pancreatic body and tail cancer.
本研究回顾性分析了胰体尾部癌侵犯脾血管的临床病理意义。
胰体尾部癌常侵犯脾动脉（SA）和脾静脉（SV），但它与其他临床病理因素的相关性及其对预后的影响尚未得到详细探讨。
本研究从前瞻性数据库中选择了 51 例行胰体尾部切除术的浸润性胰腺腺癌患者进行分析。排除了因门静脉、肝总动脉、腹腔动脉和肠系膜上动脉等主要血管侵犯而需要扩大手术的病例。分析了脾血管侵犯与预后及其他临床病理因素的关系。
17 例 SA 受侵患者的预后明显差于无 SA 受侵患者（P = 0.0067），而 24 例 SV 受侵患者的预后则无差异。此外，SA 受侵与肿瘤直径≥2cm、前腹膜浸润、神经周围侵犯和 SV 受侵显著相关（P = 0.0440，P = 0.0406，P = 0.0460，P = 0.0173）。单因素分析显示，SA 受侵、淋巴结转移和前腹膜浸润是预后不良的显著因素。多因素分析显示，只有 SA 受侵是独立的预后因素（比值比，2.611，P = 0.0196）。
本研究结果表明，SA 受侵而不是 SV 受侵是胰体尾部癌的一个重要预后因素。
