Warnick P, Bahra M, Andreou A, Neuhaus P, Glanemann M
Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Augustenburger Platz 1, 13353 Berlin, Deutschland.
Zentralbl Chir. 2010 Feb;135(1):70-4. doi: 10.1055/s-0029-1224749. Epub 2010 Feb 16.
The only curative therapy for patients with pancreatic carcinoma consists of -complete surgical tumour removal. Preoperative diagnostic investigations may help, however, the definite decision on tumour resectability can only be made intraoperatively during explorative laparotomy.
We report herein on 17 patients who were judged during exploratory laparotomy elsewhere to suffer from non-resectable pancreatic cancer and who underwent a second-look operation after referral to our hospital.
During the second-look operation 13 patients (76.5 %) underwent tumour resection, where-as in 4 patients (23.5 %) the tumour remained non-resectable. An R0 resection was achieved in 9 of 13 (69 %) and an R1 resection in 4 of 13 (31 %) patients, respectively. The classic Kausch-Whipple operation was performed in 4, pylorus-preserving pancreaticoduodenectomy in 5, and left pancreatic -resection in another 4 patients. Mean survival in patients after tumour resection was increased, reach-ing 17.6 months compared to 6.5 months in patients with non-resectable pancreatic cancer.
Our results suggest that the prediction of resectability depends highly on the experience of the surgical team. Although considered as non-resectable during prior laparotomy else-where, the majority of patients (76.5 %) suffered from a resectable tumour disease. Moreover, most of them (69 %) underwent complete (R0) -tumour removal. Thus, complex visceral operations like pancreatic carcinoma resection should preferably be performed in high-volume centres exclusively.
胰腺癌患者唯一的治愈性疗法是完整切除肿瘤。术前诊断性检查可能会有所帮助，然而，关于肿瘤可切除性的明确决定只能在术中探查性剖腹手术时做出。
我们在此报告17例患者，这些患者在其他地方进行探查性剖腹手术时被判定患有不可切除的胰腺癌，转诊至我院后接受了二次探查手术。
在二次探查手术中，13例患者（76.5%）接受了肿瘤切除，而4例患者（23.5%）的肿瘤仍不可切除。13例患者中分别有9例（69%）实现了R0切除，4例（31%）实现了R1切除。4例患者进行了经典的考施-惠普尔手术，5例进行了保留幽门的胰十二指肠切除术，另外4例进行了左胰腺切除术。肿瘤切除术后患者的平均生存期延长，达到17.6个月，而不可切除胰腺癌患者的平均生存期为6.5个月。
我们的结果表明，可切除性的预测高度依赖于手术团队的经验。尽管在其他地方先前的剖腹手术中被认为不可切除，但大多数患者（76.5%）患有可切除的肿瘤疾病。此外，其中大多数患者（69%）实现了肿瘤的完整（R0）切除。因此，像胰腺癌切除术这样的复杂内脏手术最好仅在高容量中心进行。
