Miyasaka Yoshihiro, Ohtsuka Takao, Matsuda Ryota, Mori Yasuhisa, Nakata Kohei, Ohuchida Kenoki, Nakamura Masafumi
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
Surg Today. 2020 Aug;50(8):832-840. doi: 10.1007/s00595-019-01852-3. Epub 2019 Jul 25.
Progress in diagnostic modalities, surgical procedures, and multidisciplinary treatment for pancreatic diseases has increased the number of long-term survivors after pancreatic resection. Several reports have focused on high-risk lesions (HRLs), including high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic ductal adenocarcinoma, high-grade intraductal papillary mucinous neoplasm (IPMN), and IPMN with an associated invasive carcinoma, in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The etiology of HRLs in the remnant pancreas is thought to be either isolated local recurrence of the initial lesion in the remnant pancreas or a newly developed primary lesion. Although it is difficult to distinguish between local recurrence and a new primary lesion, comparison of genetic alterations between two lesions may help with this distinction. Early detection of HRLs in the remnant pancreas may improve the prognosis of patients, and several investigators have proposed predictive factors for HRLs in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The reported short- and long-term outcomes of surgical resection of HRLs in the remnant pancreas are relatively favorable. Life-long surveillance of the remnant pancreas is recommended after partial pancreatic resection for pancreatic cancer or IPMN.
胰腺疾病诊断方法、手术操作及多学科治疗的进展增加了胰腺切除术后长期存活者的数量。有几份报告聚焦于高危病变（HRLs），包括高级别胰腺上皮内瘤变（PanIN）、胰腺导管腺癌、高级别导管内乳头状黏液性肿瘤（IPMN）以及伴有浸润性癌的IPMN，这些病变出现在因胰腺癌或IPMN行部分胰腺切除术后的残余胰腺中。残余胰腺中HRLs的病因被认为要么是初始病变在残余胰腺中的孤立局部复发，要么是新发生的原发性病变。尽管很难区分局部复发和新的原发性病变，但比较两个病变之间的基因改变可能有助于这种区分。早期检测残余胰腺中的HRLs可能改善患者的预后，并且一些研究人员提出了因胰腺癌或IPMN行部分胰腺切除术后残余胰腺中HRLs的预测因素。报告显示，对残余胰腺中HRLs进行手术切除的短期和长期结果相对良好。对于因胰腺癌或IPMN行部分胰腺切除术后的患者，建议对残余胰腺进行终身监测。
