Hashimoto Daisuke, Chikamoto Akira, Masuda Toshiro, Nakagawa Shigeki, Imai Katsunori, Yamashita Yo-Ichi, Reber Howard A, Baba Hideo
From the *Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and †Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA.
Pancreas. 2017 Oct;46(9):1083-1090. doi: 10.1097/MPA.0000000000000897.
Local recurrence of pancreatic cancer (PC) can occur in the pancreatic remnant. In addition, new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this review was to describe the characteristics and therapeutic strategy regarding remnant PC. A literature search was performed using Medline published in English according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The incidence of remnant PC has been reported to be 3% to 5%. It is difficult to distinguish local recurrence from new primary PC. Genetic diagnosis such as Kirsten rat sarcoma viral oncogene homolog mutation may resolve this problem. For patients with remnant PC, repeated pancreatectomy can be performed. Residual total pancreatectomy is the most common procedure. Recent studies have described the safety of the operation because of recent surgical progress and perioperative care. The patients with remnant PC without distant metastasis have shown good long-term outcomes, especially those who underwent repeated pancreatectomy. Adjuvant chemotherapy may contribute to longer survival. In conclusion, this review found that both local recurrence and new primary PC can develop in the pancreatic remnant. Repeated pancreatectomy for the remnant PC is a feasible procedure and can prolong patient survival.
胰腺癌(PC)的局部复发可发生于胰腺残端。此外,胰腺残端还可发生新的原发性胰腺癌。关于这种所谓的残端胰腺癌,现有数据有限。本综述的目的是描述残端胰腺癌的特征及治疗策略。根据系统评价与Meta分析的首选报告项目指南,使用英文发表的Medline进行文献检索。残端胰腺癌的发生率据报道为3%至5%。区分局部复发与新的原发性胰腺癌很困难。诸如 Kirsten 大鼠肉瘤病毒癌基因同源物突变等基因诊断可能会解决这一问题。对于残端胰腺癌患者,可进行重复胰腺切除术。残留全胰切除术是最常见的术式。由于近期手术进展和围手术期护理,近期研究描述了该手术的安全性。无远处转移的残端胰腺癌患者显示出良好的长期预后,尤其是那些接受了重复胰腺切除术的患者。辅助化疗可能有助于延长生存期。总之,本综述发现胰腺残端可发生局部复发和新的原发性胰腺癌。对残端胰腺癌进行重复胰腺切除术是一种可行的手术方式,可延长患者生存期。