Hu Hankui, Huang Bin, Zhao Jichun, Yuan Ding, Yang Yi, Xiong Fei
Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China.
World J Surg. 2017 Apr;41(4):997-1004. doi: 10.1007/s00268-016-3846-x.
Retroperitoneal paragangliomas (PGs) are a rare subgroup of neuroendocrine tumors that are commonly located alongside the abdominal aorta. Complete tumor resection is thought to be restricted in patients with major blood vessel involvement. However, no study has specifically focused on aggressive surgical treatment in such patients. We evaluated the value of en bloc resection with major blood vessel reconstruction for locally invasive retroperitoneal PGs.
Twenty-nine patients with retroperitoneal PGs with major blood vessel involvement were included in this retrospective study. Survival was compared between patients who underwent en bloc resection with major blood vessel reconstruction and those who underwent medical treatment. Prognostic predictors were analyzed in patients who underwent en bloc resection with major blood vessel reconstruction.
All 11 patients who underwent medical treatment obtained a pathological diagnosis by computed tomography-guided percutaneous needle biopsy. All 18 patients who underwent en bloc resection with major blood vessel reconstruction achieved complete tumor resection. Overall survival was higher in patients who underwent complete tumor resection than in those who underwent medical treatment (p < 0.05). No perioperative mortality occurred in patients who underwent complete tumor resection. Patients with no metastasis, no organ invasion, R0 resection, a Ki-67 index of ≤3%, and a tumor diameter of ≤11.7 cm showed better tumor-free survival (p < 0.05).
En bloc resection with major blood vessel reconstruction can be successfully performed and provide satisfactory outcomes for patients with locally invasive retroperitoneal PGs. This technique may become a standard surgical strategy for properly selected patients.
腹膜后副神经节瘤（PGs）是神经内分泌肿瘤的一个罕见亚组，通常位于腹主动脉旁。对于有大血管受累的患者，完整肿瘤切除被认为受限。然而，尚无研究专门聚焦于此类患者的积极手术治疗。我们评估了整块切除联合大血管重建治疗局部侵袭性腹膜后PGs的价值。
本回顾性研究纳入了29例有大血管受累的腹膜后PGs患者。比较了接受整块切除联合大血管重建的患者与接受内科治疗的患者的生存率。对接受整块切除联合大血管重建的患者分析了预后预测因素。
所有11例接受内科治疗的患者通过计算机断层扫描引导下经皮穿刺活检获得病理诊断。所有18例接受整块切除联合大血管重建的患者均实现了肿瘤完整切除。肿瘤完整切除的患者总生存率高于接受内科治疗的患者（p<0.05）。肿瘤完整切除的患者未发生围手术期死亡。无转移、无器官侵犯、R0切除、Ki-67指数≤3%且肿瘤直径≤11.7 cm的患者无瘤生存率更高（p<0.05）。
整块切除联合大血管重建可成功实施，为局部侵袭性腹膜后PGs患者提供满意的结果。该技术可能成为合适选择患者的标准手术策略。
