Chun Yun Shin, Milestone Barton N, Watson James C, Cohen Steven J, Burtness Barbara, Engstrom Paul F, Haluszka Oleh, Tokar Jeffrey L, Hall Michael J, Denlinger Crystal S, Astsaturov Igor, Hoffman John P
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Ann Surg Oncol. 2010 Nov;17(11):2832-8. doi: 10.1245/s10434-010-1284-9. Epub 2010 Aug 20.
Pancreatic adenocarcinoma impinging the portal and/or superior mesenteric vein (PV-SMV) is classified as borderline resectable, and preoperative chemoradiation is recommended to increase the margin-negative resection rate. There is no consensus about what degree of venous impingement constitutes borderline resectability.
All patients undergoing potentially curative pancreatectomy for pancreatic adenocarcinoma were reviewed. Venous involvement was classified by preoperative computed tomography according to Ishikawa types: (I) normal, (II) smooth shift without narrowing, (III) unilateral narrowing, (IV) bilateral narrowing, (V) bilateral narrowing with collateral veins.
From 1990-2009, 109 patients underwent resection of pancreatic adenocarcinoma involving the PV-SMV. Seventy-four patients received preoperative chemoradiation, whereas 35 did not. Patients who received preoperative therapy had a significantly longer median overall survival rate of 23 months compared with 15 months for patients without preoperative therapy (P = 0.001). Preoperative chemoradiation was associated with higher R0 resection rate and negative lymph nodes (both P < 0.0001) but did not affect the need for vein resection. When stratified by Ishikawa types, preoperative therapy was associated with improved overall survival among patients with types II and III but not types IV and V. Similarly, the correlation between preoperative therapy and R0 resection rate was observed only among patients with Ishikawa types II and III.
Preoperative therapy for borderline resectable pancreatic adenocarcinoma is associated with higher margin-negative resection and survival rates in patients with Ishikawa type II and III tumors, defined as a smooth shift or unilateral narrowing of the PV-SMV. Patients with bilateral venous narrowing were less likely to benefit from preoperative treatment.
侵犯门静脉和/或肠系膜上静脉（PV-SMV）的胰腺腺癌被归类为可切除边界肿瘤，推荐术前放化疗以提高切缘阴性切除率。对于何种程度的静脉侵犯构成可切除边界性尚无共识。
回顾性分析所有接受潜在根治性胰腺切除术治疗胰腺腺癌的患者。术前计算机断层扫描根据石川分型对静脉受累情况进行分类：（I）正常，（II）平滑移位无狭窄，（III）单侧狭窄，（IV）双侧狭窄，（V）双侧狭窄伴侧支静脉。
1990年至2009年，109例患者接受了侵犯PV-SMV的胰腺腺癌切除术。74例患者接受了术前放化疗，35例未接受。接受术前治疗的患者中位总生存期显著更长，为23个月，而未接受术前治疗的患者为15个月（P = 0.001）。术前放化疗与更高的R0切除率和阴性淋巴结相关（均P < 0.0001），但不影响静脉切除的必要性。按石川分型分层时，术前治疗与II型和III型患者的总生存期改善相关，但与IV型和V型患者无关。同样，术前治疗与R0切除率之间的相关性仅在石川II型和III型患者中观察到。
对于可切除边界性胰腺腺癌，术前治疗与石川II型和III型肿瘤（定义为PV-SMV平滑移位或单侧狭窄）患者更高的切缘阴性切除率和生存率相关。双侧静脉狭窄的患者从术前治疗中获益的可能性较小。
