Wang Guojing, Zhou Dinghua
Hepatobiliary Surgery, The Second Artillery General Hospital of PLA, China.
Hepatobiliary Surgery, The Second Artillery General Hospital of PLA, China.
Ultrason Sonochem. 2015 Nov;27:694-702. doi: 10.1016/j.ultsonch.2015.05.029. Epub 2015 Jun 9.
Currently, extended resection and preoperative neoadjuvant chemotherapy are the two main modalities for improvement of the resection rate and R0 resection rate of borderline resectable pancreatic cancer. The past few years, however, have witnessed some progress in the treatment of unresectable pancreatic cancer with high intensity focused ultrasound (HIFU). The aim of this study is twofold: first, to evaluate the feasibility and safety of HIFU ablation as a preoperative adjuvant therapy for borderline resectable pancreatic cancer, and second, to conduct pathological analyses to verify the safety and effectiveness of HIFU treatment of pancreatic cancer.
From January 2011 to December 2012, 30 patients with borderline resectable pancreatic cancer underwent HIFU ablation by Haifu Model-JC200 Focused Ultrasound Tumor Therapeutic System prior to radical surgery. The effect of pre-operative HIFU ablation was evaluated by post-HIFU functional imaging results, operation time of radical surgery, blood loss volume, R0 resection rate, postoperative 1-year survival rate and Ca199 curve. Postoperative pathological specimens were obtained for histological examination.
All 30 patients with borderline resectable pancreatic cancer had completed the treatments and follow-ups. Functional image assessment after HIFU treatment showed a mean tumor ablation rate of (61.5±24.3)%. 28 patients underwent radical resection of pancreatic cancer 7-9 days after HIFU treatment (23 cases underwent pancreaticoduodenectomy. 4 patients underwent pancreatectomy and 1 patient had total pancreatectomy). 7 patients underwent combined resection and reconstruction of portal-superior mesenteric vein (23.3%), with the resectability rate of 93.3%, the R0 resection rate of 92.7%, and the 1-year survival rate of 96.7%. The biological coagulative necrosis regions identified by the postoperative pathological examination matched well with the necrosis foci identified by post-operative functional imaging.
The effectiveness of HIFU ablation of pancreatic tumors, as well as interstitial tissues within he main vascular spaces was confirmed by post-operative pathological examinations. Based on these observations, we conclude that preoperative HIFU ablation of borderline resectable pancreatic cancer can significantly improve the resection rate, R0 resection rate, and reduce the difficulty and risk of surgery. Therefore, HIFU may be a valuable pre-operative adjunct therapy for resectable pancreatic cancer. However, the safety and the efficacy on the improvement of the surgery need to established with future multicenter, randomized studies.
目前,扩大切除术和术前新辅助化疗是提高交界可切除胰腺癌切除率和R0切除率的两种主要方式。然而,在过去几年中,高强度聚焦超声(HIFU)治疗不可切除胰腺癌取得了一些进展。本研究的目的有两个:第一,评估HIFU消融作为交界可切除胰腺癌术前辅助治疗的可行性和安全性;第二,进行病理分析以验证HIFU治疗胰腺癌的安全性和有效性。
2011年1月至2012年12月,30例交界可切除胰腺癌患者在根治性手术前接受海扶JC200型聚焦超声肿瘤治疗系统的HIFU消融。通过HIFU术后功能成像结果、根治性手术时间、失血量、R0切除率、术后1年生存率和Ca199曲线评估术前HIFU消融的效果。获取术后病理标本进行组织学检查。
30例交界可切除胰腺癌患者均完成治疗及随访。HIFU治疗后功能影像评估显示平均肿瘤消融率为(61.5±24.3)%。28例患者在HIFU治疗后7 - 9天接受胰腺癌根治性切除术(23例行胰十二指肠切除术,4例行胰腺切除术,1例行全胰切除术)。7例患者接受门静脉 - 肠系膜上静脉联合切除重建(23.3%),切除率为93.3%,R0切除率为92.7%,1年生存率为96.7%。术后病理检查确定的生物性凝固性坏死区域与术后功能成像确定的坏死灶吻合良好。
术后病理检查证实了HIFU对胰腺肿瘤以及主要血管间隙内间质组织消融的有效性。基于这些观察结果,我们得出结论,术前HIFU消融交界可切除胰腺癌可显著提高切除率、R0切除率,并降低手术难度和风险。因此,HIFU可能是可切除胰腺癌有价值的术前辅助治疗方法。然而,其安全性及对手术改善的疗效有待未来多中心随机研究确定。