Okabayashi Takehiro, Shima Yasuo, Iwata Jun, Morita Sojiro, Sumiyoshi Tatsuaki, Kozuki Akihito, Saisaka Yuichi, Tokumaru Teppei, Iiyama Tatsuo, Noda Yoshihiro, Hata Yasuhiro, Matsumoto Manabu
Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan,
Langenbecks Arch Surg. 2015 May;400(4):487-94. doi: 10.1007/s00423-015-1305-z. Epub 2015 May 6.
Some clinicians have argued that combining pancreatic and portomesenteric venous resection could improve the rates of long-term survival. However, whether resection of the portosplenomesenteric vein could provide an acceptable survival benefit to patients with pancreatic cancer involving the portosplenomesenteric system remains controversial. The purpose of this study was to determine the significance of pathological portosplenomesenteric venous invasion on survival in patients who underwent surgical management for pancreatic adenocarcinoma.
Patients who underwent curative surgical treatment were divided into two subgroups: those with pathological invasion to the portosplenomesenteric vein (PV-positive group) and those without invasion (PV-negative group).
Of 160 studied patients, the median overall survival was 48.0 months after pancreatic surgery in the PV-negative group and 18.0 months in the PV-positive group. The incidence of postoperative peritoneal dissemination was significantly lower in the PV-negative group than in the PV-positive group. Accordingly, patients in the PV-negative group showed a cumulative rate of pancreatic cancer recurrence at 2 years after pancreatic surgery of 54.4%, while this rate was 89.4% in the PV-positive group. Finally, an elevated presurgical serum CA19-9 level (>700 IU/mL) was found to be significantly associated with a poor outcome after surgery in pancreatic cancer patients with pathological portosplenomesenteric venous invasion.
Pancreatic cancer carries a high risk of recurrence even if surgical resection is technically possible. The current study suggested that portosplenomesenteric involvement and preoperative high serum CA19-9 are poor prognostic indications; however, the findings provided little insight into the role of neoadjuvant therapy in such patients.
一些临床医生认为，联合胰腺和门静脉肠系膜静脉切除术可提高长期生存率。然而，对于累及门静脉脾肠系膜系统的胰腺癌患者，切除门静脉脾肠系膜静脉是否能带来可接受的生存获益仍存在争议。本研究的目的是确定病理上门静脉脾肠系膜静脉侵犯对接受手术治疗的胰腺腺癌患者生存的意义。
接受根治性手术治疗的患者分为两个亚组：门静脉脾肠系膜静脉有病理侵犯的患者（PV阳性组）和无侵犯的患者（PV阴性组）。
在160例研究患者中，PV阴性组胰腺手术后的中位总生存期为48.0个月，PV阳性组为18.0个月。PV阴性组术后腹膜播散的发生率显著低于PV阳性组。相应地，PV阴性组患者胰腺手术后2年的胰腺癌累积复发率为54.4%，而PV阳性组为89.4%。最后，术前血清CA19-9水平升高（>700 IU/mL）被发现与病理上有门静脉脾肠系膜静脉侵犯的胰腺癌患者术后不良预后显著相关。
即使手术切除在技术上可行，胰腺癌仍有很高的复发风险。本研究表明，门静脉脾肠系膜受累和术前血清CA19-9升高是不良预后指标；然而，这些发现几乎没有揭示新辅助治疗在此类患者中的作用。
