Department of Surgery, Thomas Jefferson University, JeffersonPancreas, Biliary and Related Cancer Center, Philadelphia, PA 19107, USA.
J Gastrointest Surg. 2013 Aug;17(8):1392-8. doi: 10.1007/s11605-013-2260-z.
Distal pancreatectomy and splenectomy (DPS) is the procedure of choice for the surgical treatment of pancreatic exocrine cancer localized to the body and tail of the pancreas. Splenic vein thrombosis (SVT) can occur in patients with malignant pancreatic exocrine tumors secondary to direct tumor invasion or compression of the splenic vein by mass effect. This study examines the effect of preoperative SVT on postoperative outcomes. In this retrospective cohort study, we queried our pancreatic surgery database to identify patients who underwent DPS from October 2005 to June 2011. These cases were evaluated for evidence of preoperative SVT on clinical records and cross-sectional imaging (CT,MRI, endoscopic US). Outcomes for patients with and without SVT were compared. From an overall cohort of 285 consecutive patients who underwent DPS during the study period, data were evaluated for 70 subjects who underwent surgery for pancreatic exocrine cancer (27 with SVT, 43 without SVT). The preoperative demographics and co-morbidities were similar between the groups, except the average age was higher for those without SVT (p<0.05). The median estimated blood loss was significantly higher in the SVT group (675 versus 250 ml, p=<0.001).While the overall morbidity rates were similar between the two groups (48 % SVT versus 56% no SVT, p=NS), the group with SVT had a significantly higher rate of pancreas-specific complications, including pancreatic fistula (33 versus 7 %,p<0.01) and delayed gastric emptying (15 versus 0%, p<0.02). Hospital readmission rates were similar between the groups(30 versus 28 %, p=NS). Patients without SVT had a trend toward longer median survival (40 versus 20.8 months),although the difference was not statistically significant (p=0.1). DPS for pancreatic ductal adenocarcinoma can be performed safely in patients with SVT, but with higher intraoperative blood loss, increased pancreas-specific complications, and a trend towards lower long-term survival rates. This paper was presented as a poster at the 53rd annual meeting of the Society for Surgery of the Alimentary Tract and at the 46th annual meeting of the Pancreas Club, San Diego, CA, May 2012.
胰体尾切除术和脾切除术（DPS）是治疗胰腺外分泌癌局限于胰体和胰尾的首选手术方法。恶性胰腺外分泌肿瘤可因肿瘤直接侵犯或肿块效应压迫脾静脉而导致脾静脉血栓形成（SVT）。本研究探讨了术前 SVT 对术后结果的影响。在这项回顾性队列研究中，我们查询了我们的胰腺外科手术数据库，以确定 2005 年 10 月至 2011 年 6 月期间接受 DPS 的患者。在临床记录和横断面成像（CT、MRI、内镜超声）上评估这些病例是否存在术前 SVT 的证据。比较有和无 SVT 的患者的结果。在研究期间接受 DPS 的 285 例连续患者的总体队列中，对 70 例因胰腺外分泌癌接受手术的患者进行了数据评估（27 例有 SVT，43 例无 SVT）。两组的术前人口统计学和合并症相似，除了无 SVT 组的平均年龄较高（p<0.05）。SVT 组的中位估计出血量明显较高（675 与 250ml，p<0.001）。虽然两组的总体发病率相似（SVT 组为 48%，无 SVT 组为 56%，p=NS），但 SVT 组胰腺特异性并发症的发生率明显更高，包括胰瘘（33%与 7%，p<0.01）和胃排空延迟（15%与 0%，p<0.02）。两组的住院再入院率相似（SVT 组为 30%，无 SVT 组为 28%，p=NS）。无 SVT 组的中位生存时间有延长趋势（40 与 20.8 个月），尽管差异无统计学意义（p=0.1）。在 SVT 患者中可以安全地进行胰管腺癌的 DPS，但术中出血量增加，胰腺特异性并发症增加，长期生存率降低的趋势。本文曾作为海报在美国胃肠道外科学会第 53 届年会和第 46 届胰腺俱乐部年会上展示，会议于 2012 年 5 月在加利福尼亚州圣地亚哥举行。
