Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
Surg Today. 2013 Jan;43(1):33-9. doi: 10.1007/s00595-012-0179-8. Epub 2012 Apr 11.
Pancreatic cancer still has a poor prognosis even after curative resection because of the high incidence of postoperative liver metastasis. This study prospectively evaluated the feasibility and tolerability of portal vein infusion chemotherapy of gemcitabine (PVIG) as an adjuvant setting after pancreatic resection.
Thirteen patients enrolled in this study received postoperative chemotherapy with PVIG. The patients received intermittent administration of gemcitabine (800 mg/m(2)) via the portal vein on days 1, 8, and 15 after surgery. The tolerability and the toxicity of PVIG were closely monitored.
The PVIG was started on an average of 3.1 days after surgery. Complete doses of chemotherapy (three sessions of portal infusion) were accomplished in 11 of the 13 patients. Grade 3 or 4 leukocytopenia was observed in three patients (23 %), and liver dysfunction was found in one patient (7.7 %). Grade 2 sepsis developed in two cases due to bloodstream infection. Liver metastasis was the first site of recurrence in only two patients.
PVIG can be administered to the liver with acceptable toxicity, but myelosuppression is similar to the systemic use of gemcitabine. Careful observation is required even for locoregional chemotherapy.
即使在根治性切除术后，由于术后肝转移的高发生率，胰腺癌的预后仍然较差。本研究前瞻性评估了吉西他滨经门静脉灌注化疗（PVIG）作为胰腺切除术后辅助治疗的可行性和耐受性。
本研究纳入了 13 名接受术后 PVIG 化疗的患者。患者在术后第 1、8 和 15 天接受经门静脉间歇给予吉西他滨（800mg/m²）。密切监测 PVIG 的耐受性和毒性。
PVIG 平均在术后 3.1 天开始。13 名患者中有 11 名完成了完整剂量的化疗（三次门静脉输注）。3 名患者（23%）出现 3 或 4 级白细胞减少症，1 名患者（7.7%）出现肝功能异常。由于血流感染，有 2 例发生 2 级败血症。只有 2 例患者首先在肝脏复发转移。
PVIG 可以在可接受的毒性下给药至肝脏，但骨髓抑制与吉西他滨全身使用相似。即使是局部化疗也需要仔细观察。
