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初次胰腺切除术后残留胰腺中的胰腺癌

Pancreatic cancer in the remnant pancreas following primary pancreatic resection.

作者信息

Hashimoto Daisuke, Chikamoto Akira, Ohmuraya Masaki, Sakata Kazuya, Miyake Keisuke, Kuroki Hideyuki, Watanabe Masayuki, Beppu Toru, Hirota Masahiko, Baba Hideo

机构信息

Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.

出版信息

Surg Today. 2014 Jul;44(7):1313-20. doi: 10.1007/s00595-013-0708-0. Epub 2013 Aug 22.

DOI:10.1007/s00595-013-0708-0
PMID:23975591
Abstract

PURPOSE

To clarify the clinical features of cancer in the pancreatic remnant.

METHODS

We retrospectively reviewed the clinical and pathological findings of 10 patients who developed remnant pancreatic cancer in our hospital between 2002 and 2012. The KRAS sequences in both the initial pancreatic tumor and remnant pancreatic cancer were examined in two patients.

RESULTS

Eight patients underwent a second pancreatectomy for remnant pancreatic cancer (resected group), while two patients were not operated on and underwent chemotherapy (unresected group). The remnant pancreatic cancer developed at the cut end of the pancreas (pancreaticogastrostomy site) in four patients. In the resected group, four patients died 17 months after the emergence of the remnant pancreatic cancer and four patients survived during the median 40.5-month observation period. The median survival of the unresected group after the emergence of the remnant pancreatic cancer was 10 months. The findings of the KRAS sequencing and immunohistological staining of the remnant pancreatic cancer for MUC1 and MUC2 in the two patients were consistent with those of the initial pancreatic tumor in one patient, and not consistent in the other.

CONCLUSIONS

Our results suggest that both local recurrence and a new primary cancer can develop in the pancreatic remnant, and repeated pancreatectomy can prolong survival.

摘要

目的

阐明胰腺残端癌的临床特征。

方法

我们回顾性分析了2002年至2012年间在我院发生胰腺残端癌的10例患者的临床和病理资料。对其中2例患者的原发胰腺癌及胰腺残端癌的KRAS序列进行了检测。

结果

8例患者接受了胰腺残端癌的二次胰腺切除术（切除组），2例患者未接受手术而接受化疗（未切除组）。4例患者的胰腺残端癌发生于胰腺断端（胰胃吻合部位）。在切除组中，4例患者在胰腺残端癌出现后17个月死亡，4例患者在中位40.5个月的观察期内存活。未切除组患者在胰腺残端癌出现后的中位生存期为10个月。2例患者胰腺残端癌的KRAS测序结果及MUC1和MUC2免疫组化染色结果，1例与原发胰腺癌一致，另1例不一致。

结论

我们的结果提示，胰腺残端可发生局部复发和新发原发性癌，重复胰腺切除术可延长生存期。

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Currently Debated Topics on Surgical Treatment of Pancreatic Ductal Adenocarcinoma: A Narrative Review on Surgical Treatment of Borderline Resectable, Locally Advanced, and Synchronous or Metachronous Oligometastatic Tumor.当前关于胰腺导管腺癌外科治疗的争议话题：关于可切除边缘、局部进展期以及同时性或异时性寡转移瘤外科治疗的叙述性综述
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