肿瘤胰腺切除术中动脉切除的结果。
Outcomes of arterial resection during pancreatectomy for tumor.
作者信息
Glebova Natalia O, Hicks Caitlin W, Tosoian Jeffrey J, Piazza Kristen M, Abularrage Christopher J, Schulick Richard D, Wolfgang Christopher L, Black James H
机构信息
Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, Colo; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
出版信息
J Vasc Surg. 2016 Mar;63(3):722-9.e1. doi: 10.1016/j.jvs.2015.09.042. Epub 2015 Nov 21.
OBJECTIVE
Arterial resection (AR) during pancreatic tumor resection is controversial. We examined the safety and efficacy of AR during pancreatectomy.
METHODS
We used a prospective institutional database that includes 6522 patients who underwent pancreatectomy from 1970 to 2014; 35 had AR. We performed a 2:1 propensity match for patients without and with AR on the basis of preoperative patient and tumor variables. We then compared operative and postoperative outcomes between matched groups.
RESULTS
AR included 18 hepatic, 8 celiac, 3 splenic, 3 middle colic, 2 superior mesenteric, and 1 left renal artery. There were 20 primary, 4 vein, and 2 graft reconstructions; 11 were emergent and 24 elective. Before matching, patients with AR were younger (58 ± 2 vs 63 ± 0.2 years old; P = .05), more likely to be of black race (26% vs 9%; P = .003), to have received preoperative chemotherapy (17% vs 2%; P < .001), have a later stage and larger tumor (4 ± 0.8 vs 3 ± 0.04 cm; P = .05), more resections that included removal of all macroscopic disease, but microscopic residual tumor remained (31% vs 14%; P = .02), greater blood loss (1285 ± 276 vs 822 ± 16 mL; P = .02), and more frequent cardiac complications (11% vs 4%; P = .03) compared with patients without AR. After propensity matching, baseline patient characteristics were similar between groups. For perioperative outcomes, the groups did not differ in surgical time, blood loss, length of stay, or complications including anastomotic leaks, bleeding, cardiac, infectious complications, or liver infarct or failure (all; P = not significant). Patency was 97% at a mean follow-up of 510 ± 184 days with 1 hepatic artery AR thrombosis. Long-term outcomes were significantly different: patients with AR had a lower rate of local tumor recurrence (20% vs 47%; P = .007) but also lower 1-year (50% vs 87%; P = .002) and median survival (22 ± 18 vs 49 ± 7 months; P = .002).
CONCLUSIONS
AR during pancreatectomy is safe and not associated with increased complications. Although it significantly reduces the risk of local tumor recurrence, AR is associated with worse survival compared with patients who do not undergo AR.
目的
胰腺肿瘤切除术中进行动脉切除（AR）存在争议。我们研究了胰腺切除术中AR的安全性和有效性。
方法
我们使用了一个前瞻性机构数据库，其中包括1970年至2014年接受胰腺切除术的6522例患者；35例进行了AR。我们根据术前患者和肿瘤变量，对未进行AR和进行AR的患者进行了2:1倾向评分匹配。然后我们比较了匹配组之间的手术和术后结果。
结果
AR包括18例肝动脉、8例腹腔干、3例脾动脉、3例中结肠动脉、2例肠系膜上动脉和1例左肾动脉。有20例进行了原位血管重建、4例静脉重建和2例移植物重建；11例为急诊手术，24例为择期手术。匹配前，进行AR的患者更年轻（58±2岁 vs 63±0.2岁；P = 0.05），更可能为黑人（26% vs 9%；P = 0.003），接受术前化疗的比例更高（17% vs 2%；P < 0.001），肿瘤分期更晚且肿瘤更大（4±0.8 cm vs 3±0.04 cm；P = 0.05），更多的切除包括切除所有肉眼可见病变但仍有镜下残留肿瘤（31% vs 14%；P = 0.02），失血量更大（1285±276 mL vs 822±16 mL；P = 0.02），心脏并发症更频繁（11% vs 4%；P = 0.03）。倾向评分匹配后，两组患者的基线特征相似。对于围手术期结果，两组在手术时间、失血量、住院时间或并发症（包括吻合口漏、出血、心脏、感染性并发症或肝梗死或肝功能衰竭）方面无差异（所有P值均无统计学意义）。平均随访510±184天时通畅率为97%，有1例肝动脉AR血栓形成。长期结果有显著差异：进行AR的患者局部肿瘤复发率较低（20% vs 47%；P = 0.007），但1年生存率（50% vs 87%；P = 0.002）和中位生存期（22±18个月 vs 49±7个月；P = 0.002）也较低。
结论
胰腺切除术中的AR是安全的，且不增加并发症。虽然AR显著降低了局部肿瘤复发的风险，但与未进行AR的患者相比，其生存率更差。
Zotero 插件