Department of Hepatopancreatobiliary (HPB) and Liver Transplant Surgery, Royal Free Hospital, London, UK.
Research Department of Infection and Population Health, Royal Free Campus, University College London, London, UK.
Br J Surg. 2017 Oct;104(11):1539-1548. doi: 10.1002/bjs.10580. Epub 2017 Aug 22.
The International Study Group of Pancreatic Surgery (ISGPS) recommends operative exploration and resection of pancreatic cancers in the presence of reconstructable mesentericoportal axis involvement. However, there is no consensus on the ideal method of vascular reconstruction. The effect of depth of tumour invasion of the vessel wall on outcome is also unknown.
This was a retrospective cohort study of pancreaticoduodenectomy with vein resection for T3 adenocarcinoma of the head of the pancreas across nine centres. Outcome measures were overall survival based on the impact of the depth of tumour infiltration of the vessel wall, and morbidity, in-hospital mortality and overall survival between types of venous reconstruction: primary closure, end-to-end anastomosis and interposition graft.
A total of 229 patients underwent portal vein resection; 129 (56·3 per cent) underwent primary closure, 64 (27·9 per cent) had an end-to-end anastomosis and 36 (15·7 per cent) an interposition graft. There was no difference in overall morbidity (26 (20·2 per cent), 14 (22 per cent) and 9 (25 per cent) respectively; P = 0·817) or in-hospital mortality (6 (4·7 per cent), 2 (3 per cent) and 2 (6 per cent); P = 0·826) between the three groups. One hundred and six patients (47·5 per cent) had histological evidence of vein involvement; 59 (26·5 per cent) had superficial invasion (tunica adventitia) and 47 (21·1 per cent) had deep invasion (tunica media or intima). Median survival was 18·8 months for patients who had primary closure, 27·6 months for those with an end-to-end anastomosis and 13·0 months among patients with an interposition graft. There was no significant difference in median survival between patients with superficial, deep or no histological vein involvement (20·8, 21·3 and 13·3 months respectively; P = 0·111). Venous tumour infiltration was not associated with decreased overall survival on multivariable analysis.
In this study, there was no difference in morbidity between the three modes of venous reconstruction, and overall survival was similar regardless of tumour infiltration of the vein.
国际胰腺外科研究组（ISGPS）建议在肠系膜门静脉轴可重建的情况下，对胰腺癌进行手术探查和切除。然而，对于血管重建的理想方法尚无共识。肿瘤侵犯血管壁的深度对预后的影响也不清楚。
这是一项回顾性队列研究，研究对象为 9 个中心的胰头腺癌行胰十二指肠切除术伴静脉切除。根据血管壁肿瘤浸润深度的影响，评估总生存率，并比较静脉重建类型（端端吻合、直接吻合和中间移植）之间的发病率、住院死亡率和总生存率。
共有 229 例患者行门静脉切除术；129 例（56.3%）行端端吻合，64 例（27.9%）行直接吻合，36 例（15.7%）行中间移植。三组患者的总发病率（分别为 26 例[20.2%]、14 例[22%]和 9 例[25%]）或住院死亡率（分别为 6 例[4.7%]、2 例[3%]和 2 例[6%]）无差异（P=0.817）。106 例患者（47.5%）有静脉受累的组织学证据；59 例（26.5%）有浅部侵犯（外膜），47 例（21.1%）有深部侵犯（中膜或内膜）。行端端吻合的患者中位生存期为 18.8 个月，行直接吻合的患者中位生存期为 27.6 个月，行中间移植的患者中位生存期为 13.0 个月。在有浅部、深部或无静脉组织学受累的患者中，中位生存期无显著差异（分别为 20.8、21.3 和 13.3 个月；P=0.111）。多变量分析显示，静脉肿瘤浸润与总生存时间无相关性。
在这项研究中，三种静脉重建方式的发病率无差异，且无论静脉是否受肿瘤侵犯，总生存率相似。
