Lee Shin-Rong, Gemenetzis Georgios, Cooper Michol, Javed Ammar A, Cameron John L, Wolfgang Christopher L, Eckhauser Frederick E, He Jin, Weiss Matthew J
Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2017 Mar;24(3):801-807. doi: 10.1245/s10434-016-5619-z. Epub 2016 Oct 21.
The goal of this study was to assess the outcomes and characteristics of patients who underwent pancreatectomy for metastatic disease to the pancreas.
Patients who underwent surgical resection of metastatic disease to the pancreas from 1988 to 2016 were identified using a prospectively maintained database. Data on clinicopathological features and outcomes of these patients were analyzed. Cox proportional hazard models were employed to identify patient-specific risk factors that influence survival.
Ninety-seven patients underwent 98 pancreatic metastasectomies from July 1988 through March 2016 for metastatic disease from 13 different primary cancers. Pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 49 (50 %), 37 (38 %), and 12 (12 %) patients, respectively. Postoperative complications occurred in 55 (56 %) patients, while 3 (3 %) perioperative deaths occurred. Median follow-up was 2.0 years, with a median survival of 3.2 years. Multivariate analysis revealed that older patients [hazard ratio (HR) 1.04/year; p = 0.006], non-renal cell carcinomas (HR 5.07; p < 0.001), vascular invasion (HR 3.53; p < 0.001), and positive resection margins (HR 2.62; p = 0.008) were independently associated with an increased risk of mortality.
Pancreatic metastasectomy is safe and feasible in well-selected patients and is associated with acceptable long-term survival.
本研究的目的是评估因胰腺转移瘤而接受胰腺切除术的患者的治疗结果和特征。
使用前瞻性维护的数据库识别1988年至2016年期间因胰腺转移瘤接受手术切除的患者。分析这些患者的临床病理特征和治疗结果数据。采用Cox比例风险模型识别影响生存的患者特异性风险因素。
从1988年7月至2016年3月，97例患者因13种不同原发癌的转移瘤接受了98次胰腺转移瘤切除术。分别有49例（50%）、37例（38%）和12例（12%）患者接受了胰十二指肠切除术、胰腺远端切除术和全胰腺切除术。55例（56%）患者发生术后并发症，3例（3%）患者发生围手术期死亡。中位随访时间为2.0年，中位生存期为3.2年。多变量分析显示，老年患者[风险比（HR）1.04/年；p = 0.006]、非肾细胞癌（HR 5.07；p < 0.001）、血管侵犯（HR 3.53；p < 0.001）和切缘阳性（HR 2.62；p = 0.008）与死亡风险增加独立相关。
在精心挑选的患者中，胰腺转移瘤切除术是安全可行的，并且与可接受的长期生存相关。
