Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.
Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.
Ann Surg Oncol. 2019 Jun;26(6):1649-1656. doi: 10.1245/s10434-019-07258-2. Epub 2019 Mar 28.
Metastatic lesion to the pancreas accounts for approximately 2% of pancreatic neoplasms. There is no prospective, randomized or case-controlled study evaluating the role of pancreatic metastasectomy.
The PubMed, EMBASE, and Cochrane Library electronic databases were searched for studies published between January 1, 2001 and December 31, 2017. Studies with five or more patients who received pancreatic metastasectomy and data from our institution (29 patients) were included. The Kaplan-Meier method was used for survival analysis.
A total of 414 patients from 20 institutions who underwent pancreatic resections were included. Of the reported 31 kinds of primary neoplasms, renal-cell carcinoma (RCC) comprised the most (54.3%). At the time of diagnosis, although 40.3% patients were asymptomatic, abdominal pain (34.8%) and jaundice (20.6%) were relatively common. As for surgical type, pancreatoduodenectomy, total pancreatectomy, distal pancreatectomy, and enucleation took up 37.9%, 11.4%, 43.5%, and 7.2% respectively. The mortality and morbidity rates were 1.4% and 48.3% respectively. Patients with symptoms at the time of diagnosis had significantly shorter survival compared with asymptomatic patients (p = 0.017). Those with RCC as primary tumor had significantly longer survival compared with non-RCC patients (p < 0.001). Positive margin also predicts worse prognosis (p = 0.035).
Pancreatic metastasectomy is safe and associated with acceptable short- and intermediate-term results. In the conditions of RCC as the primary tumor, being asymptomatic, or negative resection margin, a better prognosis after resection can be achieved.
胰腺转移瘤约占胰腺肿瘤的 2%。目前尚无前瞻性、随机或病例对照研究评估胰腺转移瘤切除术的作用。
检索 2001 年 1 月 1 日至 2017 年 12 月 31 日发表的文献，纳入符合以下标准的研究：纳入胰腺转移瘤切除术患者 5 例以上的研究，且研究包含本机构数据（共 29 例患者）。采用 Kaplan-Meier 法进行生存分析。
共纳入 20 家机构的 414 例胰腺切除术患者。在报告的 31 种原发性肿瘤中，肾细胞癌（RCC）占比最高（54.3%）。诊断时，虽然 40.3%的患者无症状，但腹痛（34.8%）和黄疸（20.6%）较为常见。手术方式中，胰十二指肠切除术、全胰切除术、胰体尾切除术和肿瘤剜除术分别占 37.9%、11.4%、43.5%和 7.2%。死亡率和并发症发生率分别为 1.4%和 48.3%。诊断时存在症状的患者生存时间明显短于无症状患者（p=0.017）。以 RCC 为原发性肿瘤的患者生存时间明显长于非 RCC 患者（p<0.001）。切缘阳性也预示着预后较差（p=0.035）。
胰腺转移瘤切除术是安全的，短期和中期结果可接受。在 RCC 为原发性肿瘤、无症状和阴性切缘的情况下，切除后可获得更好的预后。
