Lopez-Lopez Victor, Robles-Campos Ricardo, López-Conesa Asunción, Brusadin Roberto, Carbonel Guillermo, Gomez-Ruiz Alvaro, Ruiz Juan J, Parrilla Pascual
Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain.
Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain -
Minerva Chir. 2019 Jun;74(3):253-262. doi: 10.23736/S0026-4733.18.07972-5. Epub 2019 Jan 2.
Once liver metastases in pancreatic and periampullary carcinoma are diagnosed, guidelines do not recommend resection of the primary tumor. In this stage of the disease, therapeutic regimes with chemotherapy are the standard treatment. However, it is unclear whether combinations of extensive surgery and novel chemotherapy treatments confer a survival benefit in selected patients.
We provide a systematic review about liver metastases in pancreatic and periampullary carcinoma treated by surgery utilizing EMBASE, Medline/PubMed, Cochrane and Scopus databases according to PRISMA guidelines.
In pancreatic and periampullary carcinoma, the number of lesions that can be resected includes a mean or median of 1-3; the size of the lesions should not exceed 3 cm and the most frequent surgical technique used were wedge or atypical resections. Overall morbidity and mortality after liver resection from pancreatic tumors were 0-68% and 0-9.1%, respectively, and from periampullary carcinomas were 0-82% and 0-21%, respectively. Considering both types of carcinomas, the rate of recurrence was up to 91%. Median overall survival ranged from 5.5 to 16.6 months for liver metastases from pancreas carcinoma, and from 5 to 23 months for periampullary carcinoma, with better prognosis for duodenal carcinomas.
Perioperative chemotherapy is the cornerstone of treatment in patients with liver metastasis from pancreatic and periampullary carcinoma. Liver resection from early liver metastases could be acceptable in selected patients with oligometastatic disease and small single lesions taking into account the individual risk of complications.
一旦诊断出胰腺和壶腹周围癌发生肝转移，指南不建议切除原发肿瘤。在疾病的这个阶段，化疗的治疗方案是标准治疗方法。然而，尚不清楚广泛手术与新型化疗联合治疗是否能使部分患者获得生存益处。
我们根据PRISMA指南，利用EMBASE、Medline/PubMed、Cochrane和Scopus数据库，对通过手术治疗的胰腺和壶腹周围癌肝转移进行了系统评价。
在胰腺和壶腹周围癌中，可切除的病灶数量平均或中位数为1 - 3个；病灶大小不应超过3 cm，最常用的手术技术是楔形或非典型切除术。胰腺肿瘤肝切除术后的总体发病率和死亡率分别为0 - 68%和0 - 9.1%，壶腹周围癌肝切除术后的总体发病率和死亡率分别为0 - 82%和0 - 21%。综合考虑这两种类型的癌症，复发率高达91%。胰腺癌肝转移患者的中位总生存期为5.5至16.6个月，壶腹周围癌肝转移患者的中位总生存期为5至23个月，十二指肠癌预后较好。
围手术期化疗是胰腺和壶腹周围癌肝转移患者治疗的基石。考虑到个体并发症风险，对于寡转移疾病且单个病灶较小的特定患者，早期肝转移灶切除可能是可以接受的。
