Marsoner Katharina, Langeder Rainer, Csengeri Dora, Sodeck Gottfried, Mischinger Hans Jörg, Kornprat Peter
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2016 Aug;128(15-16):566-72. doi: 10.1007/s00508-016-1024-7. Epub 2016 Jun 30.
Portal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma.
Single, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection. Predictors for short- and long-term survival were assessed via multivariate logistic and Cox regression.
Baseline and perioperative characteristics were similar between the two groups. However, overall skin-to-skin times, intraoperative transfusion requirements as the need for medical inotropic support were higher in patients undergoing additional portal vein resection (p < 0.0001; p = 0.001 and p = 0.03). Postoperative complication rates were 34 vs. 35 % (p = 0.89), 14 patients (5 % vs. 11 %; p = 0.18) died in-hospital. An American Society of Anesthesiologists Score >2 was the only independent predictor for in-hospital mortality (OR 10.66, 95 % CI 1.24-91.30). Follow-up was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25). For long-term outcome, microvascular invasion (HR 2.03, 95 % CI 1.10-3.76) and preoperative weight loss (HR 2.17, 95 % CI 1.31-3.58) were independent predictors.
Despite locally advanced disease, patients who underwent portal vein resection had no worse perioperative and overall survival than patients with lower staging and standard pancreaticoduodenectomy only. Therefore, the feasibility of portal vein resection should be evaluated in every potential candidate at risk.
门静脉切除是局部进展期导管腺癌标准胰十二指肠切除术中一种可行的附加选择，但由于它可能会使患者面临围手术期和术后发病及死亡的额外风险，因此常常未得到充分应用。我们旨在回顾我们的长期经验，以确定这种干预措施对局部进展期胰腺癌的附加价值。
对一个大学外科中心13年间的病例进行单中心审计；队列包括221例连续接受胰腺切除术的患者；其中47例（21%）包括门静脉切除。通过多因素逻辑回归和Cox回归评估短期和长期生存的预测因素。
两组患者的基线和围手术期特征相似。然而，接受额外门静脉切除的患者总的手术时间、术中输血需求以及对血管活性药物支持的需求更高（p < 0.0001；p = 0.001和p = 0.03）。术后并发症发生率分别为34%和35%（p = 0.89），14例患者（5%对11%；p = 0.18）在住院期间死亡。美国麻醉医师协会评分>2是住院死亡率的唯一独立预测因素（OR 10.66，95%CI 1.24 - 91.30）。随访完成率为99.5%，有和没有门静脉切除的患者1年生存率分别为59%和70%，5年总生存率分别为15%和12%（对数秩检验：p = 0.25）。对于长期预后，微血管侵犯（HR 2.03，95%CI 1.10 - 3.76）和术前体重减轻（HR 2.17，95%CI 1.31 - 3.58）是独立预测因素。
尽管疾病处于局部进展期，但接受门静脉切除的患者围手术期和总体生存率并不比分期较低且仅接受标准胰十二指肠切除术的患者差。因此，应评估每一位有风险的潜在候选患者进行门静脉切除的可行性。
