Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
J Surg Oncol. 2013 Mar;107(4):414-21. doi: 10.1002/jso.23229. Epub 2012 Aug 6.
The aim of this study was to evaluate the efficacy of portal or superior mesenteric vein (PV/SMV) resection for patients with pancreatic carcinoma who underwent pancreatoduodenectomy.
Medical records of 125 patients with pancreatic head carcinoma who underwent pancreatoduodenectomy were reviewed retrospectively. Sixty-one patients underwent PV/SMV resection and 64 patients did not. Clinicopathological factors were compared between the two groups and the prognostic impact of PV/SMV resection was evaluated using univariate and multivariate survival analysis.
The frequency of mortality and morbidity did not differ between the two groups. Univariate analysis revealed that a significant difference in overall survival was found between patients who did and did not undergo PV/SMV resection (P = 0.046) as well as between patients with and without pathological PV/SMV invasion (P = 0.012). However, PV/SMV resection and pathological PV/SMV invasion were not independent prognostic factors by multivariate survival analysis. Among patients with PV/SMV resection, the use of adjuvant chemotherapy was the only independent prognostic factor of overall survival (P = 0.003).
Resection of the PV/SMV with adjuvant chemotherapy may provide an acceptable survival benefit to patients with pancreatic head carcinoma, which involves the PV/SMV without additional mortality and morbidity.
本研究旨在评估胰十二指肠切除术治疗胰头癌患者门静脉或肠系膜上静脉（PV/SMV）切除的疗效。
回顾性分析 125 例胰头癌患者行胰十二指肠切除术的病历资料。61 例行 PV/SMV 切除术，64 例行非 PV/SMV 切除术。比较两组患者的临床病理因素，并采用单因素和多因素生存分析评估 PV/SMV 切除的预后影响。
两组患者的死亡率和发病率无差异。单因素分析显示，PV/SMV 切除组与未切除组患者的总生存率存在显著差异（P=0.046），PV/SMV 病理侵犯组与未侵犯组患者的总生存率也存在显著差异（P=0.012）。然而，PV/SMV 切除和病理 PV/SMV 侵犯不是多因素生存分析的独立预后因素。在 PV/SMV 切除的患者中，辅助化疗的应用是总生存率的唯一独立预后因素（P=0.003）。
在不增加死亡率和发病率的情况下，联合辅助化疗的 PV/SMV 切除术可能为不伴有 PV/SMV 侵犯的胰头癌患者提供可接受的生存获益。
