Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
J Hepatobiliary Pancreat Sci. 2019 May;26(5):179-186. doi: 10.1002/jhbp.618. Epub 2019 Apr 8.
Few studies of the oncological outcomes of ampullary cancer have addressed recurrence, and many treatment-related issues remain unresolved. This study evaluated optimal surgical treatment strategies based on recurrence patterns after pancreaticoduodenectomy (PD) for ampullary cancer.
Two hundred and fifty-nine patients who underwent PD with R0 resection for ampullary cancer from January 2000 to June 2012 were included. Generally, lymph node (LN) dissection extended to the right superior mesenteric artery (SMA). Recurrence was defined based on imaging studies. The first detected recurrence sites and patterns were analyzed.
During a mean follow-up of 51.3 months, recurrence occurred in 89 (34.4%) cases, most commonly in the liver. Poor differentiation, advanced T stage, and LN metastasis were identified as risk factors for recurrence. Locoregional and systemic recurrences occurred alone or simultaneously in 20.2%, 73.0%, and 6.7% of patients, respectively. Locoregional and systemic recurrences tended to occur in early- and advanced-stage cases, respectively. A nodal-type recurrence around mesenteric vessels was the most common locoregional recurrence pattern, and 58.8% (10/17) were located left of the SMA.
As nodal-type metastasis around the mesenteric vessels was the dominant recurrence pattern, careful LN dissection around the SMA should be considered for early and advanced ampullary cancers.
少数研究探讨了壶腹癌的肿瘤学结局，涉及复发问题，且许多与治疗相关的问题仍未解决。本研究评估了基于胰十二指肠切除术（PD）后壶腹癌复发模式的最佳手术治疗策略。
2000 年 1 月至 2012 年 6 月期间，259 例接受 PD 且 R0 切除治疗的壶腹癌患者被纳入本研究。一般来说，淋巴结（LN）清扫延伸至右肠系膜上动脉（SMA）。根据影像学研究定义复发。分析首次发现的复发部位和模式。
在平均 51.3 个月的随访中，89 例（34.4%）患者出现复发，最常见的复发部位是肝脏。低分化、进展期 T 分期和 LN 转移被确定为复发的危险因素。单独或同时发生局部区域和全身复发的患者分别占 20.2%、73.0%和 6.7%。局部区域和全身复发分别倾向于发生在早期和晚期病例中。肠系膜血管周围的淋巴结型复发是最常见的局部区域复发模式，其中 58.8%（10/17）位于 SMA 左侧。
由于肠系膜血管周围的淋巴结转移型是主要的复发模式，对于早期和晚期壶腹癌，应考虑在 SMA 周围进行仔细的 LN 清扫。
