Nanashima Atsushi, Tobinaga Syuuichi, Abo Takafumi, Hatano Kazuhiko, Takeshita Hiroaki, Nonaka Takashi, Hidaka Shigekazu, Tanaka Kenji, Kunizaki Masaki, Sawai Terumitsu, Yasutake Toru, Nagayasu Takeshi
Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Hepatogastroenterology. 2012 May;59(115):911-5. doi: 10.5754/hge10038.
BACKGROUND/AIMS: Surgical resection is a radical treatment option for pancreatic carcinoma (PC); however, it is still difficult to cure and patient prognosis is poor at this stage.
We examined the demographics, surgical records and outcome in 64 patients with hilar PC undergoing surgical resection.
Pancreatoduodenectomy (PD) was carried out in 48 patients, distal pancreatectomy (DP) in 14 and total pancreatectomy in two. Postoperative complications were observed in 18 patients (28%) but no hospital deaths. All stage I patients showed carcinoma in situ of intraductal papillary mucinous carcinoma (IPMC). Postoperative adjuvant chemotherapy was performed in 15 patients (23%) using gemcitabine or S-1. Cancer recurrence was observed in 36 patients (56%) and 31 died of carcinoma. The 5-year cancer-free and overall survival rate was 12% and 14%, respectively. CA19-9 level, morphological type, T category, lymph node metastasis, extrapancreatic nerve plexus invasion, retropancreatic tissue invasion, distal bile duct invasion, duodenal invasion and arterial system invasion were significant poor prognostic factors; however, portal vein system invasion was not significantly associated with prognosis. Cancer infiltration at bile duct cut-end and dissected peripancreatic tissue margin and presence of residual tumor showed a poor prognosis. Surgical prognosis in only non-invasive IPMC was satisfactory.
Radically extended surgical resection is necessary and newly effective adjuvant chemotherapy is a promising modality to improve patient survival in PC patients.
背景/目的：手术切除是胰腺癌（PC）的一种根治性治疗选择；然而，目前仍难以治愈，且此阶段患者预后较差。
我们研究了64例行手术切除的肝门部PC患者的人口统计学资料、手术记录及预后情况。
48例行胰十二指肠切除术（PD），14例行远端胰腺切除术（DP），2例行全胰切除术。18例患者（28%）出现术后并发症，但无医院死亡病例。所有I期患者均表现为导管内乳头状黏液性癌（IPMC）原位癌。15例患者（23%）使用吉西他滨或S-1进行术后辅助化疗。36例患者（56%）出现癌症复发，31例死于癌症。5年无癌生存率和总生存率分别为12%和14%。CA19-9水平、形态学类型、T分期、淋巴结转移、胰外神经丛侵犯、胰后组织侵犯、远端胆管侵犯、十二指肠侵犯及动脉系统侵犯均为显著不良预后因素；然而，门静脉系统侵犯与预后无显著相关性。胆管切端和胰周组织切缘的癌浸润及残留肿瘤的存在提示预后较差。仅非侵袭性IPMC的手术预后良好。
根治性扩大手术切除是必要的，新型有效的辅助化疗是改善PC患者生存的一种有前景的方式。
