Andreou Andreas, Klein Fritz, Schmuck Rosa B, Lee Daniela, Sinn Marianne, Denecke Timm, Pratschke Johann, Bahra Marcus
Department of Surgery, Charité Medical University of Berlin, Virchow Campus Hospital, Berlin, Germany
Berlin School of Integrative Oncology, Charité Medical University of Berlin, Virchow Campus Hospital, Berlin, Germany.
Anticancer Res. 2017 Sep;37(9):5269-5275. doi: 10.21873/anticanres.11952.
The risk for multicentricity of pancreatic adenocarcinoma remains unclear and the question whether pancreaticoduodenectomy represents sufficient oncological treatment for patients with ductal adenocarcinoma of the head of the pancreas needs further investigation.
Clinicopathological data of patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma between 2005 and 2015 were assessed and the incidence of tumor multicentricity among patients who required salvage pancreatectomy within 90 postoperative days was evaluated.
Pancreaticoduodenectomy was performed in 1,005 patients. Sixty-two patients (6%) suffered a major postoperative complication (pancreatic fistula/anastomotic leak/bleeding) after resection of the head of the pancreas, requiring salvage pancreatectomy. Histological examination of the pancreatic remnant in patients with ductal adenocarcinoma (n=19) revealed multicentric carcinoma in two patients, resulting in an incidence of 11% for tumor multicentricity. Preoperative cross-sectional imaging failed to identify tumor multicentricity in these patients. Additionally, two patients with pancreatic intraepithelial neoplasia and two with neuroendocrine tumor were identified.
The incidence of previously undetected multicentric adenocarcinoma among patients undergoing salvage pancreatectomy in our study was surprisingly high. This finding suggests that the role of total pancreatectomy for pancreatic head cancer, as well as the current strategies for postoperative tumor surveillance, should be re-evaluated in order to provide the best oncological approach and prolonged survival for patients with ductal adenocarcinoma.
胰腺腺癌多中心性的风险仍不明确，胰十二指肠切除术对于胰头导管腺癌患者是否代表充分的肿瘤治疗这一问题需要进一步研究。
评估2005年至2015年间因胰腺腺癌接受胰十二指肠切除术患者的临床病理数据，并评估术后90天内需补救性全胰切除术患者的肿瘤多中心性发生率。
1005例患者接受了胰十二指肠切除术。62例患者（6%）在胰头切除术后出现严重术后并发症（胰瘘/吻合口漏/出血），需要进行补救性全胰切除术。对导管腺癌患者（n = 19）的胰腺残端进行组织学检查发现，2例患者存在多中心癌，肿瘤多中心性发生率为11%。术前横断面成像未能识别出这些患者的肿瘤多中心性。此外，还发现了2例胰腺上皮内瘤变患者和2例神经内分泌肿瘤患者。
在我们的研究中，接受补救性全胰切除术的患者中先前未检测到的多中心腺癌发生率出奇地高。这一发现表明，应重新评估全胰切除术对胰头癌的作用以及当前的术后肿瘤监测策略，以便为导管腺癌患者提供最佳的肿瘤治疗方法并延长生存期。
