Lapshyn Hryhoriy, Bronsert Peter, Bolm Louisa, Werner Martin, Hopt Ulrich T, Makowiec Frank, Wittel Uwe A, Keck Tobias, Wellner Ulrich F, Bausch Dirk
Clinic for General and Visceral Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Langenbecks Arch Surg. 2016 Feb;401(1):63-9. doi: 10.1007/s00423-015-1363-2. Epub 2016 Jan 6.
Pancreatoduodenectomy (PD) with superior mesenteric/portal venous resection (PVR) for pancreatic ductal adenocarcinoma (PDAC) is performed routinely in case of tumor adhesion to the superior mesenteric or portal vein. True histopathological portal vein invasion (PVI) is found in a subgroup of patients. Even though this procedure has become routine in most centers for pancreatic surgery, data on prognostic factors in this situation is limited. The aim of this study was to identify prognostic factors after PD with PVR for PDAC.
Retrospective analysis was performed on the basis of a prospectively maintained database, and paraffin-embedded formalin-fixed tissue slides stained for hematoxylin-eosin were re-evaluated by two independent pathologists. Statistical analysis was conducted using MedCalc software.
From 2001 to 2012, 86 cases of PD with PVR for PDAC with long-term follow-up and sufficient tissue for re-assessment were identified. Histopathological re-review disclosed PVI in 39 resection specimens and adhesion without infiltration in 47. Overall median survival in all patients was 22 months. Patients with PVI versus no PVI showed comparable baseline demographic and standard histopathological parameters; however, PVI was associated with microscopic hemangiosis (p = 0.001) and positive margin status (p = 0.001). Median survival in patients with PVI was 14 months versus 25 months in patients without PVI (p = 0.042). Only lymph node ratio and PVI were independent predictors of survival after resection.
The only independent factors influencing overall survival after PD with PVR for PDAC were lymph node ratio and PVI. PVI might indicate aggressive tumor biology, but the available data remains controversial.
对于胰腺导管腺癌（PDAC），若肿瘤与肠系膜上静脉或门静脉粘连，则常规进行胰十二指肠切除术（PD）并联合肠系膜上静脉/门静脉切除（PVR）。部分患者存在真正的组织病理学门静脉侵犯（PVI）。尽管该手术在大多数胰腺外科中心已成为常规操作，但关于这种情况下预后因素的数据有限。本研究的目的是确定PDAC患者行PD联合PVR后的预后因素。
基于前瞻性维护的数据库进行回顾性分析，两名独立病理学家对苏木精-伊红染色的福尔马林固定石蜡包埋组织切片进行重新评估。使用MedCalc软件进行统计分析。
2001年至2012年，共确定86例因PDAC行PD联合PVR且有长期随访及足够组织用于重新评估的病例。组织病理学重新检查发现39例切除标本存在PVI，47例为粘连但无浸润。所有患者的总中位生存期为22个月。有PVI与无PVI的患者在基线人口统计学和标准组织病理学参数方面具有可比性；然而，PVI与微小血管生成（p = 0.001）和切缘阳性状态（p = 0.001）相关。有PVI患者的中位生存期为14个月，无PVI患者为25个月（p = 0.042）。只有淋巴结比率和PVI是切除术后生存的独立预测因素。
影响PDAC患者行PD联合PVR后总生存的唯一独立因素是淋巴结比率和PVI。PVI可能提示肿瘤生物学行为侵袭性强，但现有数据仍存在争议。
