Sahakyan Mushegh A, Kim Song Cheol, Kleive Dyre, Kazaryan Airazat M, Song Ki Byung, Ignjatovic Dejan, Buanes Trond, Røsok Bård I, Labori Knut Jørgen, Edwin Bjørn
The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
Surgery. 2017 Oct;162(4):802-811. doi: 10.1016/j.surg.2017.06.009. Epub 2017 Jul 27.
Surgical resection is the only curative option in patients with pancreatic ductal adenocarcinoma. Little is known about the oncologic outcomes of laparoscopic distal pancreatectomy. This bi-institutional study aimed to examine the long-term oncologic results of standard laparoscopic distal pancreatectomy in a large cohort of patients with pancreatic ductal adenocarcinoma.
From January 2002 to March 2016, 207 patients underwent standard laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma at Oslo University Hospital-Rikshospitalet (Oslo, Norway) and Asan Medical Centre (Seoul, Republic of Korea). After the exclusion criteria were applied (distant metastases at operation, conversion to an open operation, loss to follow-up), 186 patients were eligible for the analysis. Perioperative and oncologic variables were analyzed for association with recurrence and survival.
Median overall and recurrence-free survivals were 32 and 16 months, while 5-year overall and recurrence-free survival rates were estimated to be 38.2% and 35.9%, respectively. Ninety-six (52%) patients developed recurrence: 56 (30%) extrapancreatic, 27 (15%) locoregional, and 13 (7%) combined locoregional and extrapancreatic. Thirty-seven (19.9%) patients had early recurrence (within 6 months of operation). In the multivariable analysis, tumor size >3 cm and no adjuvant chemotherapy were associated with early recurrence (P = .017 and P = .015, respectively). The Cox regression model showed that tumor size >3 cm and lymphovascular invasion were independent predictors of decreased recurrence-free and overall survival.
Standard laparoscopic distal pancreatectomy is associated with satisfactory long-term oncologic outcomes in patients with pancreatic ductal adenocarcinoma. Several risk factors, such as tumor size >3 cm, no adjuvant chemotherapy, and lymphovascular invasion, are linked to poor prognosis after standard laparoscopic distal pancreatectomy.
手术切除是胰腺导管腺癌患者唯一的治愈选择。关于腹腔镜远端胰腺切除术的肿瘤学结局知之甚少。这项双机构研究旨在探讨标准腹腔镜远端胰腺切除术在一大群胰腺导管腺癌患者中的长期肿瘤学结果。
2002年1月至2016年3月，207例患者在挪威奥斯陆大学医院Rikshospitalet（挪威奥斯陆）和韩国峨山医学中心（韩国首尔）接受了标准腹腔镜远端胰腺切除术治疗胰腺导管腺癌。应用排除标准（手术时远处转移、转为开放手术、失访）后，186例患者符合分析条件。分析围手术期和肿瘤学变量与复发和生存的相关性。
中位总生存期和无复发生存期分别为32个月和16个月，5年总生存率和无复发生存率分别估计为38.2%和35.9%。96例（52%）患者出现复发：56例（30%）为胰腺外复发，27例（15%）为局部区域复发，13例（7%）为局部区域和胰腺外联合复发。37例（19.9%）患者早期复发（术后6个月内）。在多变量分析中，肿瘤大小>3 cm和未接受辅助化疗与早期复发相关（分别为P = 0.017和P = 0.015）。Cox回归模型显示，肿瘤大小>3 cm和淋巴管侵犯是无复发生存期和总生存期降低的独立预测因素。
标准腹腔镜远端胰腺切除术在胰腺导管腺癌患者中具有令人满意的长期肿瘤学结局。一些危险因素，如肿瘤大小>3 cm、未接受辅助化疗和淋巴管侵犯，与标准腹腔镜远端胰腺切除术后的不良预后相关。
