King's College Hospital, Institute of Liver Studies, London SE5 9RS, UK.
Surgeon. 2012 Apr;10(2):102-6. doi: 10.1016/j.surge.2011.12.001. Epub 2011 Dec 30.
The first case-series of pancreatectomy with synchronous en-bloc vascular resection with the aim to improve pancreatic cancer survival was published in 1977. Advances in surgical techniques, intensive care management and teaching centers with high volume cases have dramatically reduced mortality and morbidity of major pancreatic resections. This has led to a progressively wider use of venous and/or arterial resections during pancreatic surgery in selected patients to achieve negative resection margins.
We review the current literature and discuss our experience in pancreatectomies with en-bloc vascular resections.
Survival of patients with pancreatic cancer who undergo an R0 resection with venous reconstruction is comparable to those who have a standard pancreaticoduodenectomy with no added mortality or morbidity. Conversely, arterial resection is associated with a higher morbidity, mortality and overall poorer survival, perhaps reflecting more advanced disease.
Since the need for vascular resection may not be always apparent on pre-operative imaging, surgeons who perform major pancreatic surgery should be familiar with vascular resection and reconstruction techniques in order to offer to these patients the best chance to prolong survival.
1977 年首次发表了旨在提高胰腺癌生存率的胰腺切除术联合同步整块血管切除术的病例系列研究。手术技术、重症监护管理和高容量病例教学中心的进步，大大降低了主要胰腺切除术的死亡率和发病率。这导致在选定的患者中，为了达到阴性切缘，在胰腺手术中越来越广泛地进行静脉和/或动脉切除术。
我们复习了目前的文献，并讨论了我们在整块血管切除术联合胰腺切除术方面的经验。
接受 R0 切除术联合静脉重建的胰腺癌患者的生存率与接受标准胰十二指肠切除术的患者相当，且无额外的死亡率或发病率。相反，动脉切除术与更高的发病率、死亡率和总体较差的生存率相关，这可能反映了更晚期的疾病。
由于术前影像学检查不一定能明确是否需要血管切除术，因此进行大型胰腺手术的外科医生应该熟悉血管切除术和重建技术，以便为这些患者提供延长生存的最佳机会。
