接受手术探查但未行切除术的胰腺癌患者的全国性结局。

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer.

机构信息

Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.

Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.

出版信息

Br J Surg. 2017 Oct;104(11):1568-1577. doi: 10.1002/bjs.10602. Epub 2017 Aug 22.

DOI:10.1002/bjs.10602

PMID:28832964

Abstract

BACKGROUND

Despite improvements in diagnostic imaging and staging, unresectable pancreatic cancer is still encountered during surgical exploration with curative intent. This nationwide study investigated outcomes in patients with unresectable pancreatic cancer found during surgical exploration.

METHODS

All patients diagnosed with primary pancreatic (adeno)carcinoma (2009-2013) in the Netherlands Cancer Registry were included. Predictors of unresectability, 30-day mortality and poor survival were evaluated using logistic and Cox proportional hazards regression analysis.

RESULTS

There were 10 595 patients with pancreatic cancer during the study interval. The proportion of patients undergoing surgical exploration increased from 19·9 to 27·0 per cent (P < 0·001). Among 2356 patients who underwent surgical exploration, the proportion of patients with tumour resection increased from 61·6 per cent in 2009 to 71·3 per cent in 2013 (P < 0·001), whereas the contribution of M1 disease (18·5 per cent overall) remained stable. Patients who had exploration only had an increased 30-day mortality rate compared with those who underwent tumour resection (7·8 versus 3·8 per cent; P < 0·001). In the non-resected group, among those with M0 (383 patients) and M1 (435) disease at surgical exploration, the 30-day mortality rate was 4·7 and 10·6 per cent (P = 0·002), median survival was 7·2 and 4·4 months (P < 0·001), and 1-year survival rates were 28·0 and 12·9 per cent, respectively. Among other factors, low hospital volume (0-20 resections per year) was an independent predictor for not undergoing tumour resection, but also for 30-day mortality and poor survival among patients without tumour resection.

CONCLUSION

Exploration and resection rates increased, but one-third of patients who had surgical exploration for pancreatic cancer did not undergo resection. Non-resectional surgery doubled the 30-day mortality rate compared with that in patients undergoing tumour resection.

摘要

背景

尽管诊断成像和分期技术有所提高，但仍有患者在以治愈为目的的手术探查中被发现患有无法切除的胰腺癌。本项全国性研究调查了在手术探查中发现无法切除的胰腺癌患者的结局。

方法

所有在荷兰癌症登记处被诊断为原发性胰腺（腺）癌（2009-2013 年）的患者均被纳入本研究。使用逻辑回归和 Cox 比例风险回归分析评估无法切除的预测因素、30 天死亡率和不良生存。

结果

研究期间共有 10595 例胰腺癌患者。接受手术探查的患者比例从 19.9%增加到 27.0%（P<0.001）。在 2356 例接受手术探查的患者中，肿瘤切除患者的比例从 2009 年的 61.6%增加到 2013 年的 71.3%（P<0.001），而 M1 期疾病（总体占 18.5%）的比例保持稳定。仅接受探查的患者与接受肿瘤切除的患者相比，30 天死亡率更高（7.8%比 3.8%；P<0.001）。在未切除的患者中，在接受手术探查时患有 M0（383 例）和 M1（435 例）疾病的患者中，30 天死亡率分别为 4.7%和 10.6%（P=0.002），中位生存时间分别为 7.2 个月和 4.4 个月（P<0.001），1 年生存率分别为 28.0%和 12.9%。在其他因素中，医院低手术量（每年 0-20 例切除术）是未进行肿瘤切除术的独立预测因素，但也是未切除肿瘤患者 30 天死亡率和不良生存的独立预测因素。