胰十二指肠切除术中肠系膜上动脉后上方第一支解剖法与经典方法的比较：病例匹配研究结果

Posterior Superior Mesenteric Artery First Dissection Versus Classical Approach in Pancreaticoduodenectomy: Outcomes of a Case-Matched Study.

作者信息

Vallance Abigail E, Young Alastair L, Pandanaboyana Sanjay, Lodge Jeremy Peter, Smith Andrew M

机构信息

From the *Department of Pancreatic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK; and †Department of HPB Surgery, Auckland City Hospital, Auckland, New Zealand.

出版信息

Pancreas. 2017 Feb;46(2):276-281. doi: 10.1097/MPA.0000000000000748.

DOI:10.1097/MPA.0000000000000748

PMID:28060185

Abstract

OBJECTIVES

Posterior superior mesenteric artery (SMA) first dissection in pancreaticoduodenectomy (PD) may allow for early assessment of resectability and aberrant anatomy. Study objectives were to compare resection margins, perioperative outcomes, disease-free survival (DFS) and overall survival (OS) in patients undergoing a posterior SMA first dissection PD to a classical technique PD.

METHODS

Patients (n = 77) who underwent a posterior SMA first PD for adenocarcinoma were case matched for patient and tumor characteristics with patients undergoing a classical approach PD from 2006 to 2014 (n = 177).

RESULTS

The SMA first patients had an improved negative resection margin rate (27 [35.1%] vs 14 [18.2%], P = 0.042) and a higher lymph node yield (median 28 [22-34] vs 21 [17-27], P < 0.001) compared with the classical approach group. No difference was demonstrated in serious complications or 30-day mortality between the SMA first and classical approach patients (Clavien-Dindo 3/4 16 [20.8%] vs 11 [14.3%], P = 0.336; 30-day mortality 3 [3.9%] vs 3 [3.9%], P = 1.00 respectively). Median DFS and OS was similar in SMA first compared with classical approach patients (DFS, 1.6 vs 1.1 years, P = 0.122; OS, 2.5 vs 1.5 years, P = 0.220 respectively).

CONCLUSIONS

A posterior SMA first approach is a comparably safe technique that may improve oncological results in PD compared with classical approach dissection.

摘要

目的

在胰十二指肠切除术（PD）中先进行肠系膜上动脉（SMA）后方解剖，可能有助于早期评估可切除性及异常解剖结构。本研究的目的是比较先进行SMA后方解剖的PD患者与采用传统技术的PD患者的切缘、围手术期结局、无病生存期（DFS）和总生存期（OS）。

方法

2006年至2014年，对因腺癌接受SMA后方优先PD的患者（n = 77），按患者和肿瘤特征与接受传统方法PD的患者进行病例匹配（n = 177）。

结果

与传统方法组相比，SMA优先解剖的患者阴性切缘率更高（27例[35.1%]对14例[18.2%]，P = 0.042），淋巴结获取量更多（中位数28个[22 - 34个]对21个[17 - 27个]，P < 0.001）。SMA优先解剖组与传统方法组在严重并发症或30天死亡率方面无差异（Clavien - Dindo 3/4级：16例[20.8%]对11例[14.3%]，P = 0.336；30天死亡率：3例[3.9%]对3例[3.9%]，P = 1.00）。与传统方法组患者相比，SMA优先解剖组患者的DFS和OS中位数相似（DFS，1.6年对1.1年，P = 0.122；OS，2.5年对1.5年，P = 0.220）。