Hepatopancreatobiliary Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Br J Surg. 2013 Sep;100(10):1349-56. doi: 10.1002/bjs.9222.
The management of portal vein (PV) involvement by pancreatic adenocarcinoma during pancreaticoduodenectomy (PD) is controversial. The aim of this study was to compare the outcomes of unplanned and planned PV resections as part of PD.
An analysis of PD over 11 years was performed. Patients who had undergone PV resection (PV-PD) were identified, and categorized into those who had undergone planned or unplanned resection. Postoperative and oncological outcomes were compared.
Of 249 patients who underwent PD for pancreatic adenocarcinoma, 66 (26·5 per cent) had PV-PD, including 27 (41 per cent) planned and 39 (59 per cent) unplanned PV resections. Twenty-five of 27 planned PV resections were circumferential PV-PD, whereas 25 of 39 unplanned PV resections were partial PV-PD. Planned PV resections were performed in slightly younger patients (mean(s.d.) 60(9) versus 65(10) years; P = 0·031), and associated with longer operating times (mean(s.d.) 602(131) versus 458(83) min; P < 0·001) and more major complications (26 versus 5 per cent; P = 0·026). Planned PV resections were associated with a lower rate of positive margins (4 versus 44 per cent; P < 0·001) despite being carried out for larger tumours (mean(s.d.) 3·9(1·4) versus 2·9(1·0) cm; P = 0·002). There was no difference in survival between the two groups (P = 0·998). On multivariable analysis, margin status was a significant predictor of survival.
Although planned PV resections for pancreatic adenocarcinoma were associated with higher rates of postoperative morbidity than unplanned resections, R0 resection rates were better.
在胰十二指肠切除术（PD）中，对于胰腺癌累及门静脉（PV）的处理存在争议。本研究旨在比较 PD 中计划性和非计划性 PV 切除的结果。
对 11 年来的 PD 进行了分析。确定了接受 PV 切除（PV-PD）的患者，并将其分为计划性和非计划性切除。比较了术后和肿瘤学结果。
在 249 例接受 PD 治疗的胰腺腺癌患者中，66 例（26.5%）行 PV-PD，其中 27 例（41%）为计划性，39 例（59%）为非计划性。27 例计划性 PV 切除中，25 例行环形 PV-PD，39 例非计划性 PV 切除中，25 例行部分 PV-PD。计划性 PV 切除术的患者年龄稍轻（平均（标准差）60（9）岁比 65（10）岁；P=0.031），手术时间较长（平均（标准差）602（131）分钟比 458（83）分钟；P<0.001），且主要并发症发生率较高（26%比 5%；P=0.026）。尽管计划切除的肿瘤较大（平均（标准差）3.9（1.4）cm 比 2.9（1.0）cm；P=0.002），但计划性 PV 切除的阳性切缘率较低（4%比 44%；P<0.001）。两组患者的生存情况无差异（P=0.998）。多变量分析显示，切缘状态是生存的显著预测因素。
虽然计划行 PV 切除术治疗胰腺癌与非计划性切除术相比，术后并发症发生率较高，但 R0 切除率更高。
