Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
J Hepatobiliary Pancreat Sci. 2010 Jul;17(4):516-22. doi: 10.1007/s00534-009-0257-5. Epub 2010 Feb 3.
The surgical decision regarding where to resect the pancreas is an important judgement that is directly linked to the surgical procedure. An appropriate surgical margin to resect intraductal papillary-mucinous neoplasm (IPMN) of the pancreas based on the distance of tumor spread (DTS) in the main pancreatic duct has not been adequately documented. We analyzed the appropriate surgical margin based on the DTS in the main pancreatic duct of IPMN and the positive rate at the pancreatic cut end margin.
Forty patients with main duct- or mixed-type IPMN diagnosed histopathologically who underwent surgery at Tokai University Hospital between 1991 and 2008 were retrospectively analyzed. The resection line was determined to achieve a 2-cm surgical margin in patients with main duct- or mixed-type IPMN and as limited a resection as possible to remove the dilated branch duct in patients with branch duct-type IPMN according to macroscopic type. The dysplastic state of the epithelium was judged as positive for carcinoma in situ (high-grade dysplasia) or adenoma (very low to moderate dysplasia) and judged as negative for hyperplasia or normal.
The mean DTS in the main pancreatic duct was 41.6 +/- 30.0 mm, and that of the distance of tumor absence was 13.6 +/- 12.4 mm. The positive rate at the pancreatic cut end margin in frozen sections was 29.7%. The final positive rate at the pancreatic cut end margin was 26.2%. There has been no evidence of local recurrence in the remnant pancreas. DTS in the main pancreatic duct of IPMN was correlated with the maximum diameter of the duct (R = 0.678).
Distance of tumor spread offered important insights about the appropriate site to resect the pancreas and the positive rate at the cut end margin in IPMN.
胰腺切除部位的手术决策是一个重要的判断，它与手术过程直接相关。基于主胰管肿瘤扩散距离（DTS）适当切除胰腺导管内乳头状黏液性肿瘤（IPMN）的手术切缘尚未得到充分证明。我们分析了基于主胰管内 IPMN 的 DTS 和胰腺切缘阳性率的适当手术切缘。
回顾性分析了 1991 年至 2008 年在东海大学医院接受手术的 40 例经组织病理学诊断为主胰管型或混合性 IPMN 的患者。根据大体类型，主胰管型或混合性 IPMN 患者的切除线确定为 2cm 手术切缘，分支胰管型 IPMN 患者尽可能行局限性切除术以切除扩张的分支胆管。上皮的发育不良状态被判断为原位癌（高级别异型增生）或腺瘤（低至高异型增生）阳性，增生或正常为阴性。
主胰管的平均 DTS 为 41.6±30.0mm，无肿瘤缺失的距离为 13.6±12.4mm。冷冻切片的胰腺切缘阳性率为 29.7%。胰腺切缘的最终阳性率为 26.2%。残留胰腺无局部复发证据。IPMN 主胰管的 DTS 与胆管最大直径相关（R=0.678）。
肿瘤扩散距离为胰腺切除的适当部位和 IPMN 切缘的阳性率提供了重要的见解。
