Amano Ryosuke, Kimura Kenjiro, Nakata Bunzo, Yamazoe Sadaaki, Motomura Hisashi, Yamamoto Akira, Tanaka Sayaka, Hirakawa Kosei
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Surgery. 2015 Jul;158(1):191-200. doi: 10.1016/j.surg.2015.02.016. Epub 2015 Apr 18.
Pancreatic cancer (PC) with arterial invasion is currently a contraindication to resection and has a miserable prognosis.
Seventeen patients with locally advanced PC involving the celiac axis and/or common hepatic artery (CHA) who received chemoradiotherapy (CRT) composed of gemcitabine, S-1, and external beam irradiation over the last 2 years were investigated. Thirteen patients underwent pancreatectomy with major arterial resection: 6 distal pancreatectomies with resection of the celiac axis, 4 total pancreatectomies with resection of both the celiac axis and the CHA, and 3 pancreatoduodenectomies with resection of the CHA. Preoperative arterial embolization and/or arterial reconstruction to prevent ischemic gastropathy and hepatopathy was performed in 7 of the 13 patients.
Distant metastases were found in 3 patients after CRT. One patient did not consent to operation after CRT. The morbidity rate of the 13 patients who underwent surgery was 62% (8/13), but no deaths occurred. Although there were no responders on CT, >90% of tumor cells were necrotic on histopathology in 5 of 13 tumors after CRT. Invasion of the celiac axis remained in 5 tumors, and extrapancreatic plexus invasion remained in 8 tumors, but an R0 resection was achieved in 12 of 13 tumors. Lymph node metastases were found in 3 of 13 cases. The overall 1-year survival rate from commencement of CRT and resection was 12 of 13 patients.
Neoadjuvant CRT containing gemcitabine and S-1 and subsequent pancreatectomy with major arterial resection for patients with locally advanced PC with arterial invasion were carried out safely with an acceptable R0 resection acceptable morbidity and mortality, and encouraging survival (12 of 13) at 1 year postoperatively.
伴有动脉侵犯的胰腺癌（PC）目前是手术切除的禁忌证，预后较差。
对过去2年中接受由吉西他滨、S-1和外照射组成的放化疗（CRT）的17例局部晚期PC累及腹腔干和/或肝总动脉（CHA）的患者进行了研究。13例患者接受了主要动脉切除的胰腺切除术：6例远端胰腺切除术伴腹腔干切除，4例全胰腺切除术伴腹腔干和CHA切除，3例胰十二指肠切除术伴CHA切除。13例患者中的7例进行了术前动脉栓塞和/或动脉重建以预防缺血性胃病和肝病。
CRT后3例患者发现远处转移。1例患者CRT后不同意手术。13例接受手术的患者的发病率为62%（8/13），但无死亡发生。尽管CT上无反应者，但CRT后13个肿瘤中的5个在组织病理学上>90%的肿瘤细胞坏死。5个肿瘤仍有腹腔干侵犯，8个肿瘤仍有胰腺外神经丛侵犯，但13个肿瘤中的12个实现了R0切除。13例中有3例发现淋巴结转移。从CRT开始至切除的总体1年生存率为13例患者中的12例。
对于伴有动脉侵犯的局部晚期PC患者，采用含吉西他滨和S-1的新辅助CRT以及随后的主要动脉切除的胰腺切除术安全实施，R0切除可接受，发病率和死亡率可接受，术后1年生存率令人鼓舞（13例中的12例）。
