Department of Gastroenterology Hepatology and Nutrition, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Dig Dis Sci. 2011 Dec;56(12):3678-84. doi: 10.1007/s10620-011-1815-7. Epub 2011 Jul 13.
To study pre-operative and peri-operative course and outcome on follow up after pancreaticoduodenenctomy (PD) for resectable pancreatic cancer amongst patients receiving self-expanding metal stents (SEMS).
Medical charts of consecutively reviewed patients (2005-2009) with resectable pancreatic cancer and SEMS placement before PD at the MD Anderson Cancer Center (MDACC) were studied.
Seventy-nine patients (mean age, 68 ± 9 years; 54% males) undergoing PD after SEMS placement were analyzed. Of these, 70% (55/79) had come with previous plastic stents placed within a median of 29 (5-216) days because of presentation and most (95%) underwent neoadjuvant chemoradiation after SEMS placement. The median interval between SEMS placement and PD was 120 (range 28-306) days. There were no technical difficulties during PD. The resected tumor was stage T3 in 72 patients, positive node in 44, lymphovascular invasion in 47, and perineural invasion in 62. Within 30 days after surgery, 26 (33%) patients developed complications requiring intervention, but none died. During a median follow-up of 349 (14-1,508) days after surgery, 32 (41%) patients developed metastatic disease, and 20 (25%) died; median survival was approximately 3 years. Development of metastatic disease during follow-up independently predicted survival with hazard ratio of 16 (95% CI: 4-68; P = 0.0001).
Contrary to the tendency of avoiding the use of metal stents for biliary decompression amongst patients with resectable pancreatic cancer, our study demonstrated that SEMS did not adversely affect surgical technique, postoperative course, or long-term outcome. Therefore, metal stents should be considered for patients with resectable pancreatic cancer who will undergo preoperative chemoradiation.
研究在接受自膨式金属支架（SEMS）的可切除胰腺癌患者中，术前和围手术期的经过以及胰十二指肠切除术（PD）后的随访结果。
研究了在 MD 安德森癌症中心（MDACC）接受 PD 前放置 SEMS 的可切除胰腺癌患者的病历（2005-2009 年连续回顾）。
分析了 79 例接受 SEMS 放置后 PD 的患者（平均年龄，68 ± 9 岁；54%为男性）。其中，70%（55/79）因就诊前放置了塑料支架，中位时间为 29（5-216）天，大多数（95%）在放置 SEMS 后接受了新辅助放化疗。SEMS 放置与 PD 之间的中位间隔时间为 120（范围 28-306）天。PD 过程中没有技术困难。72 例患者的切除肿瘤分期为 T3，44 例患者的淋巴结阳性，47 例患者的血管淋巴管侵犯，62 例患者的神经侵犯。术后 30 天内，26（33%）例患者发生需要干预的并发症，但无死亡。在术后中位随访 349（14-1508）天期间，32（41%）例患者发生转移性疾病，20（25%）例患者死亡；中位生存时间约为 3 年。随访期间发生转移性疾病与生存独立相关，风险比为 16（95%CI：4-68；P=0.0001）。
与避免在可切除胰腺癌患者中使用金属支架进行胆道减压的趋势相反，我们的研究表明，SEMS 不会对手术技术、术后过程或长期结果产生不利影响。因此，对于将接受术前放化疗的可切除胰腺癌患者，应考虑使用金属支架。
