Haines Morgan, Chua Terence C, Jamieson Nigel B, Mittal Anubhav, Gill Anthony J, Samra Jaswinder S
From the Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales.
Department of Surgery, QE II Jubilee Hospital, Brisbane.
Pancreas. 2020 May/Jun;49(5):621-628. doi: 10.1097/MPA.0000000000001551.
The development of increasingly effective chemotherapy regimens and increasing tumor necrosis is allowing radical pancreatectomy to be re-evaluated. This systematic review examines the outcome of patients with locally advanced cancer of the pancreatic head after pancreatectomy with arterial resection. Electronic searches were performed on PubMed and Medline databases between January 2000 and December 2018. The end points were to determine the safety and overall survival after arterial resection in pancreatectomy. Thirteen studies with 467 patients were included. Celiac, hepatic, mesenteric, and splenic arteries were resected across all studies. The median overall morbidity was 52% (range, 37%-100%) and with major complications occurring in a median of 25% (range, 12%-54%) of patients. The median 90-day mortality was 5% (range, 0%-17%). R0 was achieved in 66% (range, 43%-100%) and R1 in 31% (range, 0%-74%). The median survival was 17 (range, 7-29) months with a 1- and 3-year survival of 59% (range, 16%-92%) and 17% (range, 0%-13%), respectively. Pancreatectomy with arterial resection may be safely performed in high-volume centers with acceptable survival results in highly selected patients. Pooling of data through a multi-institutional registry will allow a more accurate assessment of the safety and efficacy of this treatment strategy.
越来越有效的化疗方案的发展以及肿瘤坏死的增加，使得根治性胰腺切除术需要重新评估。本系统评价研究了胰头局部晚期癌患者行胰腺切除联合动脉切除术后的结局。于2000年1月至2018年12月在PubMed和Medline数据库进行电子检索。终点指标是确定胰腺切除术中动脉切除后的安全性和总生存期。纳入了13项研究，共467例患者。所有研究均涉及腹腔干、肝动脉、肠系膜动脉和脾动脉的切除。总体并发症发生率中位数为52%（范围37%-100%），主要并发症发生率中位数为25%（范围12%-54%）。90天死亡率中位数为5%（范围0%-17%）。R0切除率为66%（范围43%-100%），R1切除率为31%（范围0%-74%）。中位生存期为17个月（范围7-29个月），1年和3年生存率分别为59%（范围16%-92%）和17%（范围0%-13%）。在高容量中心，对经过严格筛选的患者进行胰腺切除联合动脉切除可安全实施，且生存结果可接受。通过多机构注册登记汇总数据，将能更准确地评估该治疗策略的安全性和有效性。
