Okada Ken-Ichi, Kawai Manabu, Hirono Seiko, Miyazawa Motoki, Kitahata Yuji, Ueno Masaki, Hayami Shinya, Shimokawa Toshio, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Clinical Study Support Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Langenbecks Arch Surg. 2018 Aug;403(5):561-571. doi: 10.1007/s00423-018-1692-z. Epub 2018 Jun 28.
Risk factors of ischemic gastropathy (IG) following distal pancreatectomy with en bloc celiac axis resection (DP-CAR) remain unclear.
Fifty consecutive patients with pancreatic cancer who underwent DP-CAR were retrospectively reviewed for possible risk factors for IG. This study was registered on the UMIN Clinical Trials Registry (UMIN 000028732).
Complications higher than grade 3 were observed in 21 patients (42%) and mortality in 4 (8%). Left gastric artery (LGA) resection (P = 0.046) and a combination of left inferior phrenic artery (IPA) with LGA resection (P = 0.012) were risk factors of IG, and an elevated creatine kinase (CK) value ≥ 1005 IU/L (P = 0.025) was associated with IG. Among prognostic factors, IG (OR, 5.997; 95% CI, 1.543-23.309; P = 0.010), completion of adjuvant chemotherapy (OR, 0.282; 95% CI, 0.121-0.654; P = 0.003), longer operative time (OR, 2.261; 95% CI, 1.084-4.714; P = 0.030), and higher age (OR, 2.212; 95% CI, 1.081-4.524; P = 0.030) remained independent predictors of survival. Comparison at 2 and 3 months postoperatively showed nutritional values were higher in patients who underwent LGA-preserving DP-CAR than those with LGA-resecting DP-CAR: total protein (7.17 ± 0.56 vs 6.65 ± 0.66 g/dl, P = 0.007), albumin (4.04 ± 0.45 vs 3.43 ± 0.43 g/dl, P < 0.001), and total cholesterol (162.3 ± 34.7 vs 141.6 ± 27.2 mg/dl, P = 0.044).
The poorer prognosis in patients who undergo DP-CAR may be related to more advanced tumors. A combination of left IPA and LGA resection was a significant risk factor for IG. IG, completion of adjuvant chemotherapy, longer operative time, and higher age remain good independent predictors of survival.
胰体尾联合腹腔干整块切除（DP-CAR）术后缺血性胃病（IG）的危险因素尚不清楚。
回顾性分析50例连续接受DP-CAR的胰腺癌患者，以寻找IG的可能危险因素。本研究已在UMIN临床试验注册中心注册（UMIN 000028732）。
21例患者（42%）出现3级以上并发症，4例（8%）死亡。胃左动脉（LGA）切除（P = 0.046）以及左膈下动脉（IPA）与LGA切除联合（P = 0.012）是IG的危险因素，肌酸激酶（CK）值升高≥1005 IU/L（P = 0.025）与IG相关。在预后因素中，IG（OR，5.997；95%CI，1.543 - 23.309；P = 0.010）、辅助化疗完成情况（OR，0.282；95%CI，0.121 - 0.654；P = 0.003）、手术时间延长（OR，2.261；95%CI，1.084 - 4.714；P = 0.030）和年龄较大（OR，2.212；95%CI，1.081 - 4.524；P = 0.030）仍然是生存的独立预测因素。术后2个月和3个月的比较显示，保留LGA的DP-CAR患者的营养指标高于切除LGA的DP-CAR患者：总蛋白（7.17±0.56 vs 6.65±0.66 g/dl，P = 0.007）、白蛋白（4.04±0.45 vs 3.43±0.43 g/dl，P < 0.001）和总胆固醇（162.3±34.7 vs 141.6±27.2 mg/dl，P = 0.044）。
接受DP-CAR的患者预后较差可能与肿瘤进展程度较高有关。左IPA与LGA切除联合是IG的重要危险因素。IG、辅助化疗完成情况、手术时间延长和年龄较大仍然是生存的良好独立预测因素。
