Jacob Joseph M, Cary Clint, Jiang Song, Foster Richard S, House Michael G
Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Urology. 2017 Jan;99:169-173. doi: 10.1016/j.urology.2016.04.061. Epub 2016 Sep 19.
To describe patient characteristics and outcomes after duodenal repair during postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and to identify treatment and management patterns.
The Indiana University Testis Cancer database was used to identify all patients who underwent simultaneous partial duodenectomy and PC-RPLND from 1983 to 2013. Patient records were reviewed to describe patient and tumor characteristics, type of duodenal restoration, postoperative management, and complications.
Of the 2223 PC-RPLND performed during the study period, we identified 39 patients who underwent simultaneous duodenectomy, with 1 patient requiring 2 duodenal procedures for a total of 40 duodenal procedures. The postchemotherapy median tumor mass size was 8.95 (2.5-17) cm. Fifty percent of cases were standard PC-RPLND; the remainders were redo, desperation, or late relapse cases. Preoperative gastrointestinal symptoms were present in 21% of patients and included bowel obstruction (8%) or gastrointestinal bleeding (13%). Retroperitoneal pathology consisted of teratoma (48%), cancer (33%), and necrosis (20%). Duodenal involvement was managed with primary duodenorrhaphy (68%), duodenojejunostomy (18%), duodenoduodenostomy (13%), or pancreaticoduodenectomy (3%). Starting in the year 2000, duodenostomy and gastrostomy tubes were no longer used. The most common postoperative complication was ileus (45%) with a 3% duodenal fistula rate.
Duodenal tumor involvement during PC-RPLND is most commonly managed with primary duodenorrhaphy after partial duodenectomy with an acceptable duodenal fistula rate. The routine use of duodenostomy or gastrostomy tubes is not recommended.
描述化疗后腹膜后淋巴结清扫术（PC-RPLND）期间十二指肠修复后的患者特征及结局，并确定治疗和管理模式。
利用印第安纳大学睾丸癌数据库，识别1983年至2013年间同时接受部分十二指肠切除术和PC-RPLND的所有患者。回顾患者记录以描述患者和肿瘤特征、十二指肠修复类型、术后管理及并发症。
在研究期间进行的2223例PC-RPLND中，我们识别出39例同时接受十二指肠切除术的患者，其中1例患者需要进行2次十二指肠手术，共40次十二指肠手术。化疗后肿瘤肿块的中位大小为8.95（2.5 - 17）厘米。50%的病例为标准PC-RPLND；其余为再次手术、绝望手术或晚期复发病例。21%的患者术前有胃肠道症状，包括肠梗阻（8%）或胃肠道出血（13%）。腹膜后病理包括畸胎瘤（48%）、癌症（33%）和坏死（20%）。十二指肠受累的处理方式包括一期十二指肠缝合术（68%）、十二指肠空肠吻合术（18%）、十二指肠十二指肠吻合术（13%）或胰十二指肠切除术（3%）。从2000年开始，不再使用十二指肠造口术和胃造口术管。最常见的术后并发症是肠梗阻（45%），十二指肠瘘发生率为3%。
PC-RPLND期间十二指肠肿瘤受累最常见的处理方式是部分十二指肠切除术后进行一期十二指肠缝合术，十二指肠瘘发生率可接受。不建议常规使用十二指肠造口术或胃造口术管。
