Ben-Ishay Offir, Ariche Arie, Lachter Jesse, Kluger Yoram
Department of General Surgery, Rambam Health Care Campus. Haifa, Israel.
JOP. 2011 Mar 9;12(2):145-8.
Metastatic and locally advanced disease is unfortunately a common clinical occurrence in patients affected by pancreatic cancer. The most frequent sites of metastasis are the liver and the peritoneal lining. The falciform and round ligaments are routinely resected and sent for pathology, but no metastases have ever been reported.
In this study, we assess whether the falciform and round ligaments are possible sites for metastases and if routine pathology examination of these structures is justified.
Retrospective, single institution study.
The charts of all patients who underwent pancreatic resection from June 2005 through January 2011 were reviewed retrospectively. Data on age, gender, type of operation performed, preoperative CA 19-9 levels, vascular and perineural invasion, tumor differentiation and pathological staging were retrieved from the hospital electronic data base. Only patients with malignant lesions of the pancreas were included in the study.
Presence of pancreatic metastasis in the falciform and round ligaments.
Fifty-seven patients were included in the study. Forty patients had undergone pancreaticoduodenectomies, 10 subtotal pancreatectomies, 2 total pancreatectomies, and 1 distal pancreatectomy. Four patients had exploratory laparotomy but exploration revealed stage III or IV disease, thus the planned resection was not carried out. The falciform and round ligaments were all negative for metastasis in all patients.
Metastatic progression of pancreatic cancer is poorly understood. Theoretically, metastases to the falciform and round ligaments could occur by either contiguous, hematogenic or lymphatic spread. In our study, none of the patients had metastases to the falciform and round ligaments, regardless of the pathological staging.
We concluded that routine pathological examination of the falciform and round ligaments is not justified if the surgeon elects to remove the structures for ease of exploration and retraction during surgery. This may lighten the workload and reduce costs in a busy pathology laboratory.
不幸的是，转移性和局部晚期疾病在胰腺癌患者中是常见的临床情况。最常见的转移部位是肝脏和腹膜。镰状韧带和圆韧带通常会被切除并送去做病理检查，但从未有过转移的报告。
在本研究中，我们评估镰状韧带和圆韧带是否可能是转移部位，以及对这些结构进行常规病理检查是否合理。
回顾性单机构研究。
回顾性分析2005年6月至2011年1月期间所有接受胰腺切除术患者的病历。从医院电子数据库中获取患者的年龄、性别、手术类型、术前CA 19-9水平、血管和神经周围侵犯、肿瘤分化及病理分期等数据。本研究仅纳入胰腺恶性病变患者。
镰状韧带和圆韧带中胰腺转移的情况。
本研究共纳入57例患者。40例行胰十二指肠切除术，10例行胰腺次全切除术，2例行全胰切除术，1例行胰体尾切除术。4例患者行剖腹探查术，但探查发现为Ⅲ期或Ⅳ期疾病，因此未进行计划中的切除术。所有患者的镰状韧带和圆韧带均未发现转移。
胰腺癌的转移进展尚不清楚。理论上，镰状韧带和圆韧带的转移可能通过直接蔓延、血行或淋巴转移发生。在我们的研究中，无论病理分期如何，均未发现患者的镰状韧带和圆韧带发生转移。
我们得出结论，如果外科医生为便于手术中的探查和牵拉而选择切除镰状韧带和圆韧带，那么对其进行常规病理检查是不合理的。这可能会减轻繁忙病理实验室的工作量并降低成本。
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