Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, PR China.
Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, PR China.
Int J Surg. 2017 Dec;48:149-154. doi: 10.1016/j.ijsu.2017.10.066. Epub 2017 Nov 6.
The objectives of this systematic review and meta-analysis were to examine morbidity, mortality, and long-term survival after surgical resection of hepatic metastases from pancreatic ductal adenocarcinoma (PDAC) patients.
Patients with hepatic metastases from pancreatic ductal adenocarcinoma are facing a dilemma of whether to make hepatic resection.
A systematic literature research was undertaken through computerized databases as well as manually research from unpublished data. A meta-analysis was performed to investigate the differences in the efficacy of liver resection and non-surgical treatments based on the evaluation of morbidity, 30-day mortality, and 1-, 3-, or 5-year survival.
11 cohort studies with 1147 patients were identified in the pool. Compared with the non-surgical approach, hepatic resection can be performed in a safe and feasible manner for all pancreatic cancer patients with liver metastases (p = 0.13 for overall morbidity; p = 0.63 for mortality). For surgical group, the median 1-year, 3-year, and 5-year survival were 40.9%, 13.3%, 2.9%, respectively, with a median survival of 9.9 months. Surgical resection of hepatic metastases was associated with a significantly improved overall 1-year and 3-year survival (p < 0.001).
Hepatic resection is a safe procedure; furthermore, it is worth doing such an extended surgery for PDAC patients due to additional survival benefit in the medium-term (less than 3 years). However, further randomized, controlled trials are urgently needed.
本系统评价和荟萃分析的目的是研究胰腺导管腺癌（PDAC）患者肝转移灶切除术后的发病率、死亡率和长期生存率。
胰腺导管腺癌肝转移患者面临着是否进行肝切除术的困境。
通过计算机数据库和未发表数据的手动检索进行系统文献检索。进行荟萃分析，根据发病率、30 天死亡率以及 1 年、3 年或 5 年生存率评估，调查肝切除术和非手术治疗的疗效差异。
共纳入 11 项队列研究，共计 1147 例患者。与非手术方法相比，所有胰腺癌症肝转移患者均可安全可行地进行肝切除术（总体发病率为 p = 0.13；死亡率为 p = 0.63）。手术组的 1 年、3 年和 5 年中位生存率分别为 40.9%、13.3%和 2.9%，中位生存时间为 9.9 个月。肝转移灶切除术与整体 1 年和 3 年生存率的显著改善相关（p < 0.001）。
肝切除术是一种安全的手术；此外，对于 PDAC 患者，由于在中期（3 年以内）具有额外的生存获益，因此进行这种扩大手术是值得的。然而，迫切需要进一步的随机对照试验。
