Department of Surgery, Charité - Universitätsmedizin Berlin, Germany.
Department of Surgery, Charité - Universitätsmedizin Berlin, Germany.
Eur J Surg Oncol. 2018 Jul;44(7):1094-1099. doi: 10.1016/j.ejso.2018.05.002. Epub 2018 May 9.
Extended pancreatic resections including resections of the portal (PV) may nowadays be performed safely. Limitations in distinguishing tumor involvement from inflammatory adhesions however lead to portal vein resections (PVR) without evidence of tumor infiltration in the final histopathological examination. The aim of this study was to analyze the impact of these "false negative" resections on operative outcome and long-term survival.
40 patients who underwent pancreatic resection with PVR for pancreatic adenocarcinoma (PA) without tumor infiltration of the PV (PVR-group) were identified. In a 1:3 match these patients were compared to 120 patients after standard pancreatic resection without PVR (SPR-group) with regard to operative outcome and overall survival.
Survival analysis revealed that median survival was significantly shorter in the PVR group (311 days) as compared to the SPR group (558 days), (p = 0.0011, hazard ratio 1.98, 95% CI: 1.31-2.98). Also postoperative complications ≥ Clavien III occurred significantly more often in the PVR group (37.5% vs. 20.8%).
Radical resection affords the best chance for long-term survival in patients with PA. Based on the results of this study a routine resection of the PV as recently proposed may however not be recommended.
如今，包括门静脉（PV）切除在内的胰腺扩大切除术可以安全进行。然而，由于难以区分肿瘤浸润与炎症粘连，导致在最终的组织病理学检查中发现没有肿瘤浸润的情况下进行门静脉切除术（PVR）。本研究旨在分析这些“假阴性”切除术对手术结果和长期生存的影响。
确定了 40 名因胰腺腺癌（PA）而接受胰腺切除术且存在 PV 无肿瘤浸润的 PVR（PVR 组）患者。通过 1:3 匹配，将这些患者与未进行 PVR 的标准胰腺切除术患者（SPR 组）在手术结果和总生存方面进行比较。
生存分析显示，PVR 组的中位生存期明显短于 SPR 组（311 天对 558 天）（p=0.0011，风险比 1.98，95%CI：1.31-2.98）。PVR 组术后并发症≥Clavien III 也明显更常见（37.5%对 20.8%）。
根治性切除术为 PA 患者提供了长期生存的最佳机会。基于本研究的结果，最近提出的常规门静脉切除术可能不被推荐。
