结肠癌行胰十二指肠切除术联合结肠切除术：一项全国性回顾性分析。

Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis.

作者信息

Marsman E Madelief, de Rooij Thijs, van Eijck Casper H, Boerma Djamila, Bonsing Bert A, van Dam Ronald M, van Dieren Susan, Erdmann Joris I, Gerhards Michael F, de Hingh Ignace H, Kazemier Geert, Klaase Joost, Molenaar I Quintus, Patijn Gijs A, Scheepers Joris J, Tanis Pieter J, Busch Olivier R, Besselink Marc G

机构信息

Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.

Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

Surgery. 2016 Jul;160(1):145-152. doi: 10.1016/j.surg.2016.02.022. Epub 2016 Apr 5.

DOI:10.1016/j.surg.2016.02.022

PMID:27059639

Abstract

BACKGROUND

Microscopically radical (R0) resection of pancreatic, periampullary, or colon cancer may occasionally require a pancreatoduodenectomy with colon resection (PD-colon), but the benefits of this procedure have been disputed, and multicenter studies on morbidity and oncologic outcomes after PD-colon are lacking. This study aimed to assess complications and survival after PD-colon.

METHODS

Patients who had undergone PD-colon from 2004-2014 in 1 of 13 centers were analyzed retrospectively. Ninety-day morbidity was scored using the Clavien-Dindo score and the Comprehensive Complication Index (CCI, 0 = no complications, 100 = death). Survival was analyzed per histopathologic diagnosis.

RESULTS

After screening 3,218 consecutive PDs, 50 (1.6%) PD-colon patients (median age 66 years [interquartile range 55-72], 33 [66%] men) were included. Twenty-three (46%) patients had pancreatic ductal adenocarcinoma (PDAC), 19 (38%) other pathology, and 8 (16%) colon cancer. Ninety-day Clavien-Dindo ≥3 complications occurred in 30 (60%) patients without differences per diagnosis (P > .99); mean CCI was 39 (standard deviation 27). Colonic anastomosis leak, pancreatic fistula, and 90-day mortality occurred in 3 (6%), 2 (4%), and 4 (8%) patients, respectively. A total of 11/23 (48%) patients with PDAC and 8/8 (100%) patients with colon cancer underwent an R0 resection. Patients with PDAC had a median postoperative survival of 13 months (95% confidence interval = 5-21). One-, 3-, and 5-year cumulative survival was 56%, 21%, and 14%, respectively. Median survival after R0 resection for PDAC was 21 months (95% confidence interval = 6-35). All patients with colon cancer were alive at end of follow-up (median 24 months [95% confidence interval = 9-110]).

CONCLUSION

In this retrospective, multicenter study, PD-colon was associated with considerable complications and acceptable survival rates when a tumor negative resection margin was achieved.

摘要

背景

胰腺、壶腹周围或结肠癌的显微镜下根治性（R0）切除有时可能需要行胰十二指肠切除术加结肠切除术（PD-结肠切除术），但该手术的益处一直存在争议，且缺乏关于PD-结肠切除术后发病率和肿瘤学结局的多中心研究。本研究旨在评估PD-结肠切除术后的并发症和生存率。

方法

对2004年至2014年在13个中心之一接受PD-结肠切除术的患者进行回顾性分析。采用Clavien-Dindo评分和综合并发症指数（CCI，0=无并发症，100=死亡）对90天发病率进行评分。根据组织病理学诊断分析生存率。

结果

在筛选了3218例连续的胰十二指肠切除术后，纳入了50例（1.6%）PD-结肠切除术患者（中位年龄66岁[四分位间距55-72]，33例[66%]为男性）。23例（46%）患者患有胰腺导管腺癌（PDAC），19例（38%）为其他病理类型，8例（16%）为结肠癌。30例（60%）患者发生90天Clavien-Dindo≥3级并发症，各诊断组之间无差异（P>.99）；平均CCI为39（标准差27）。结肠吻合口漏、胰瘘和90天死亡率分别发生在3例（6%）、2例（4%）和4例（8%）患者中。23例PDAC患者中有11例（48%）和8例结肠癌患者中的8例（100%）接受了R0切除。PDAC患者的术后中位生存期为13个月（95%置信区间=5-21）。1年、3年和5年累积生存率分别为56%、21%和14%。PDAC患者R0切除术后的中位生存期为21个月（95%置信区间=6-35）。所有结肠癌患者在随访结束时均存活（中位时间24个月[95%置信区间=9-110]）。