Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Departments of General, Visceral and Transplantation Surgery, University of Munich, Munich, Germany.
Br J Surg. 2016 Nov;103(12):1683-1694. doi: 10.1002/bjs.10221. Epub 2016 Sep 30.
In the recent International Study Group of Pancreatic Surgery (ISGPS) consensus on extended pancreatectomy, several issues on perioperative outcome and long-term survival remained unclear. Robust data on outcomes are sparse. The present study aimed to assess the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer.
A consecutive series of patients with primary pancreatic adenocarcinoma undergoing extended pancreatectomies, as defined by the new ISGPS consensus, were compared with patients who had a standard pancreatectomy. Univariable and multivariable analysis was performed to identify risk factors for perioperative mortality and characteristics associated with survival. Long-term outcome was assessed by means of Kaplan-Meier analysis.
The 611 patients who had an extended pancreatectomy had significantly greater surgical morbidity than the 1217 patients who underwent a standard resection (42·7 versus 34·2 per cent respectively), and higher 30-day mortality (4·3 versus 1·8 per cent) and in-hospital mortality (7·5 versus 3·6 per cent) rates. Operating time of 300 min or more, extended total pancreatectomy, and ASA fitness grade of III or IV were associated with increased in-hospital mortality in multivariable analysis, whereas resections involving the colon, portal vein or arteries were not. Median survival and 5-year overall survival rate were reduced in patients having extended pancreatectomy compared with those undergoing a standard resection (16·1 versus 23·6 months, and 11·3 versus 20·6 per cent, respectively). Older age, G3/4 tumours, two or more positive lymph nodes, macroscopic positive resection margins, duration of surgery of 420 min or above, and blood loss of 1000 ml or more were independently associated with decreased overall survival.
Extended resections are associated with increased perioperative morbidity and mortality, particularly when extended total pancreatectomy is performed. Favourable long-term outcome is achieved in some patients.
在最近的国际胰腺外科研究组（ISGPS）关于扩大胰腺切除术的共识中，围手术期结果和长期生存的几个问题仍不清楚。关于结果的可靠数据很少。本研究旨在评估扩大胰腺切除术治疗边界可切除和局部进展期胰腺癌的效果。
连续系列接受新 ISGPS 共识定义的扩大胰腺切除术的原发性胰腺腺癌患者与接受标准胰腺切除术的患者进行比较。进行单变量和多变量分析，以确定围手术期死亡率的危险因素以及与生存相关的特征。通过 Kaplan-Meier 分析评估长期结果。
611 例接受扩大胰腺切除术的患者的手术发病率明显高于 1217 例接受标准切除术的患者（分别为 42.7%和 34.2%），30 天死亡率（4.3%和 1.8%）和住院死亡率（7.5%和 3.6%）也更高。多变量分析显示，手术时间 300 分钟或更长时间、全胰腺扩大切除术和 ASA 适应等级为 III 或 IV 与住院死亡率增加相关，而涉及结肠、门静脉或动脉的切除术则不然。与接受标准切除术的患者相比，接受扩大胰腺切除术的患者的中位生存时间和 5 年总生存率降低（16.1 个月与 23.6 个月，11.3%与 20.6%）。年龄较大、G3/4 肿瘤、两个或更多阳性淋巴结、肉眼阳性切缘、手术时间 420 分钟或以上以及出血量 1000 毫升或以上与总生存率降低独立相关。
扩大切除术与围手术期发病率和死亡率增加相关，特别是当进行全胰腺扩大切除术时。一些患者可获得良好的长期结果。
