意外的IV期胰腺导管腺癌姑息性切除术后生存率提高。
Improved survival after palliative resection of unsuspected stage IV pancreatic ductal adenocarcinoma.
作者信息
Kim Younghwan, Kim Song Cheol, Song Ki Byoung, Kim Jayoun, Kang Dae Ryong, Lee Jae Hoon, Park Kwang-Min, Lee Young-Joo
机构信息
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
出版信息
HPB (Oxford). 2016 Apr;18(4):325-31. doi: 10.1016/j.hpb.2015.10.014. Epub 2016 Feb 8.
BACKGROUND
Palliative resection of stage IV pancreatic ductal adenocarcinoma (PDAC) has not shown its benefit until now. In our retrospective review, we compared the results of palliative resection to non-resection.
METHODS
Between 2000 and 2009, metastasis of PDAC was confirmed in the operating room in 150 patients. 35 underwent palliative resection (resection group; R) and 115 did bypass or biopsy. 35 patients (biopsy or bypass group: NR) in the 115 patients were matched with the patients undergoing resection for tumor size and the metastasis of peritoneal seeding. Demographic, clinical, operative data and survival were analyzed.
RESULTS
There was no significant difference of major complication (Clavien-Dindo classification 3-5) between two groups. There was no 30-day mortality in either group. More patients in R received postoperative chemotherapy (82.9% vs. 57.1%; P = 0.019). Multivariate analysis showed resection and postoperative chemotherapy as independent factor related to survival (hazard ratio, 0.44; 95% CI, 0.25-0.76; P = 0.003). Patients in R showed better survival rates compared to those in NR (P < 0.001).
CONCLUSION
Our study suggests resection for stage IV PDAC can be associated with increased survival. In patients of stage IV PDAC, palliative resection with chemotherapy could have some benefit in selected patients.
背景
迄今为止，IV期胰腺导管腺癌（PDAC）的姑息性切除尚未显示出其益处。在我们的回顾性研究中，我们比较了姑息性切除与未切除的结果。
方法
2000年至2009年间，150例患者在手术室确诊为PDAC转移。35例行姑息性切除（切除组；R），115例行旁路手术或活检。在115例患者中，35例（活检或旁路组：NR）根据肿瘤大小和腹膜种植转移情况与接受切除的患者进行匹配。分析了人口统计学、临床、手术数据和生存率。
结果
两组主要并发症（Clavien-Dindo分类3-5级）无显著差异。两组均无30天死亡率。R组更多患者接受术后化疗（82.9%对57.1%；P = 0.019）。多变量分析显示，切除和术后化疗是与生存相关的独立因素（风险比，0.44；95%CI，0.25-0.76；P = 0.003）。与NR组相比，R组患者生存率更高（P < 0.001）。
结论
我们的研究表明，IV期PDAC的切除可能与生存率提高相关。对于IV期PDAC患者，姑息性切除联合化疗可能对部分患者有益。
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