Hirota Masahiko, Ogawa Michio
Kumamoto Regional Medical Center, Kumamoto, Japan.
JOP. 2014 May 27;15(3):243-9. doi: 10.6092/1590-8577/2502.
Pancreatectomy is the only effective treatment for cancers of the pancreas. Surgeons usually grasp tumors during pancreatectomy; however, this procedure may increase the risk of squeezing and shedding of the cancer cells into the portal vein, retroperitoneum, and/or peritoneal cavity. In an effort to overcome these problems, we have developed surgical techniques for no-touch pancreatectomy.
From April 2008 through September 2013, 52 patients have been operated on no-touch pancreatectomy for invasive ductal carcinoma of the pancreas by a single operator (M.H.). Among them, 40 received pancreatoduodenectomy (PD), and 12 did distal pancreatectomy (DP). Twenty two cases (42%) required SMV-PV resection. This is a study to see if pancreatectomy can be technically done using a no-touch surgical technique without deteriorating the post-operative prognosis. During the procedure, the pancreatic tumor is neither grasped nor squeezed by the surgeon. Furthermore, for improved dissection of the retroperitoneal tissue (leftward and posterior margins for PD and rightward and posterior margins for DP), we use a hanging and clamping maneuver and dissection behind Gerota fascia.
Overall 2- and 5-year survival rates were 64 and 42% with mean follow-up periods of 34.4 months (range: 6-68 months). Recurrence free 2- and 5-year survival rates were 49 and 31%, respectively. The 5-year survival rates of patients with JPS-stage III and those with JPS-stage IV were 57 and 20%, respectively. The 5-year survival rates of patients with UICC-stage IIA and those with UICC- stage IIB were 49 and 39%, respectively. Patients with UICC-stage III or IV did not survive for more than 2 years.
No-touch pancreatectomy has many theoretic advantages that merit further investigation in future randomized controlled trials.
胰腺切除术是治疗胰腺癌的唯一有效方法。外科医生在胰腺切除术中通常会抓取肿瘤；然而，此操作可能会增加癌细胞挤压和脱落至门静脉、腹膜后和/或腹腔的风险。为了克服这些问题，我们开发了免接触胰腺切除术的手术技术。
从2008年4月至2013年9月，由一名手术医生（M.H.）对52例胰腺浸润性导管癌患者实施了免接触胰腺切除术。其中，40例行胰十二指肠切除术（PD），12例行远端胰腺切除术（DP）。22例（42%）需要进行肠系膜上静脉-门静脉切除。本研究旨在观察是否可以在不影响术后预后的情况下，采用免接触手术技术完成胰腺切除术。在手术过程中，外科医生既不抓取也不挤压胰腺肿瘤。此外，为了更好地解剖腹膜后组织（PD的向左和向后边缘以及DP的向右和向后边缘），我们采用悬吊和钳夹操作以及在肾周筋膜后进行解剖。
总体2年和5年生存率分别为64%和42%，平均随访期为34.4个月（范围：6 - 68个月）。无复发生存2年和5年生存率分别为49%和31%。日本胰腺学会（JPS）III期患者和JPS IV期患者的5年生存率分别为57%和20%。国际抗癌联盟（UICC）IIA期患者和UICC IIB期患者的5年生存率分别为49%和39%。UICC III期或IV期患者的生存时间不超过2年。
免接触胰腺切除术具有许多理论优势，值得在未来的随机对照试验中进一步研究。
