Department of Hepatobiliary Surgery, Chinese PLA 309 Hospital, Beijing 100091, China.
World J Gastroenterol. 2010 Oct 28;16(40):5104-10. doi: 10.3748/wjg.v16.i40.5104.
To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with (125)iodine seed implantation for unresectable pancreatic cancer.
Thirty-two patients (21 males and 11 females) at the age of 68 years (range 48-90 years) with unresectable locally advanced pancreatic cancer admitted to our hospital from January 2006 to May 2008 were enrolled in this study. The tumor, 4-12 cm in diameter, located in pancreatic head of 23 patients and in pancreatic body and tail of 9 patients, was found to be unresectable during operation. Diagnosis of pancreatic cancer was made through intraoperative biopsy. Patients were treated with FRA combined with (125)iodine seed implantation. In brief, a RFA needle was placed, which was confirmed by intraoperative ultrasound to decrease the potential injury of surrounding vital structures, a (125)iodine seed was implanted near the blood vessels and around the tumor border followed by bypass palliative procedure (cholangio-jejunostomy and/or gastrojejunostomy) in 29 patients.
The serum CA 19-9 level was decreased from 512 ± 86 U/mL before operation to 176 ± 64 U/mL, 108 ± 42 U/mL and 114 ± 48 U/mL, respectively, 1, 3 and 6 mo after operation (P < 0.05). The pain score on day 7 after operation, 1 and 3 mo after combined therapy was decreased from 5.86 ± 1.92 before operation to 2.65 ± 1.04, 1.65 ± 0.88 and 2.03 ± 1.16, respectively, after operation (P < 0.05). The rate of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) in 32 patients was 21.8% (7/32), 56.3% (18/32), 15.6% (5/32) and 6.3% (2/32), respectively, 6 mo after operation, with a median overall survival time of 17. 5 mo. The median survival time of patients at stage III was longer than that of those at stage IV (19 mo vs 10 mo, P = 0.0026). The median survival time of patients who received and did not receive chemotherapy after operation was 20 mo and 16 mo, respectively (P = 0.0176). Of the 32 patients, 3 (10.6%) experienced postoperative complications including transient biliary leaks in 2 patients and acute pancreatitis in 1 patient. All the patients recovered well after conservative support treatment.
Intraoperative RFA combined with (125)iodine seed implantation is a feasible and safe procedure for unresectable pancreatic cancer with acceptable minor complications, and can prolong the survival time of patients, especially those at stage III.
评估术中射频消融（RFA）联合（125）碘籽植入治疗不可切除胰腺癌的可行性、疗效和安全性。
2006 年 1 月至 2008 年 5 月，我院收治 32 例不可切除局部晚期胰腺癌患者（男 21 例，女 11 例），年龄 68 岁（48-90 岁）。术中发现肿瘤位于胰头 23 例，胰体尾部 9 例，直径 4-12cm，无法切除。通过术中活检诊断为胰腺癌。患者接受 RFA 联合（125）碘籽植入治疗。术中将 RFA 针放置在肿瘤内，术中超声确认以减少对周围重要结构潜在损伤，在血管附近和肿瘤边缘植入（125）碘籽，随后在 29 例患者中进行旁路姑息性手术（胆管空肠吻合术和/或胃空肠吻合术）。
血清 CA19-9 水平在术前为 512±86U/mL，术后 1、3、6 个月分别降至 176±64U/mL、108±42U/mL 和 114±48U/mL（P<0.05）。术后第 7 天、1 个月和 3 个月的疼痛评分分别从术前的 5.86±1.92 降至术后的 2.65±1.04、1.65±0.88 和 2.03±1.16（P<0.05）。32 例患者中完全缓解（CR）、部分缓解（PR）、稳定（SD）和进展（PD）的比例分别为 21.8%（7/32）、56.3%（18/32）、15.6%（5/32）和 6.3%（2/32），术后 6 个月，中位总生存期为 17.5 个月。III 期患者的中位总生存期长于 IV 期患者（19 个月 vs 10 个月，P=0.0026）。术后接受和未接受化疗的患者中位生存期分别为 20 个月和 16 个月（P=0.0176）。32 例患者中，3 例（10.6%）发生术后并发症，包括 2 例暂时性胆漏和 1 例急性胰腺炎，所有患者经保守支持治疗后均恢复良好。
术中 RFA 联合（125）碘籽植入治疗不可切除胰腺癌是一种可行且安全的方法，并发症可接受，可延长患者生存时间，尤其是 III 期患者。
