Thiels Cornelius A, Bergquist John R, Laan Danuel V, Croome Kristopher P, Smoot Rory L, Nagorney David M, Thompson Geoffrey B, Kendrick Michael L, Farnell Michael B, Truty Mark J
Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA.
Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
J Gastrointest Surg. 2016 May;20(5):891-8. doi: 10.1007/s11605-016-3102-6. Epub 2016 Feb 29.
Efficacy and outcomes of resection for pancreatic neuroendocrine tumors (pNET) are well established; specific data on outcomes for pancreaticoduodenectomy (PD), either alone or with combined procedures, are limited. A retrospective review of PDs for pNET (1998-2014) at our institution was conducted. Patients were categorized into standard PD (SPD) alone or combined PD (CPD) defined as patients undergoing concurrent vascular reconstruction or additional organ resection for curative intent. Kaplan-Meier survival analyses were performed. PD for pNET was performed for 95 patients. Tumors were functional in 11 patients (9 %). Twenty-six patients (28 %) underwent CPD. The 30/90-day mortality was 1.1/5.3 % respectively and similar between SPD and CPD (p = 0.61/p = 0.24). Five-year overall survival after PD for pNET was 85.1/71.9 % and similar between SPD/CPD groups (p = 0.17). Recurrence-free and overall survival for low-grade tumors was 74.7/93.9 % at 5 years compared to only 14.8/49.7 % for high-grade tumors (p < 0.001) and not predicted by extent of resection (SPD/CPD, respectively). PD with or without concurrent resection provides an acceptable, perioperative and long-term oncologic, outcome for pNET. CPD is justified treatment modality, particularly for patients with low-grade tumors. The need for combinatorial procedures during PD is not contraindication alone for otherwise resectable patients with pNET.
胰腺神经内分泌肿瘤（pNET）切除的疗效和结果已得到充分证实；关于单纯胰十二指肠切除术（PD）或联合手术的结果的具体数据有限。我们对本机构1998 - 2014年因pNET行PD的患者进行了回顾性研究。患者被分为单纯标准PD（SPD）或联合PD（CPD），CPD定义为为达到治愈目的同时进行血管重建或额外器官切除的患者。进行了Kaplan - Meier生存分析。95例患者接受了pNET的PD手术。11例患者（9%）的肿瘤具有功能性。26例患者（28%）接受了CPD。30/90天死亡率分别为1.1%/5.3%，SPD和CPD之间相似（p = 0.61/p = 0.24）。pNET行PD后的5年总生存率为85.1%/71.9%，SPD/CPD组之间相似（p = 0.17）。低级别肿瘤的5年无复发生存率和总生存率分别为74.7%/93.9%，而高级别肿瘤仅为14.8%/49.7%（p < 0.001），且不受切除范围（分别为SPD/CPD）的影响。有无同期切除的PD对pNET患者而言，围手术期和长期肿瘤学结局均可接受。CPD是合理的治疗方式，尤其对于低级别肿瘤患者。对于其他可切除的pNET患者，PD期间联合手术的需求本身并非禁忌证。
