胰腺神经内分泌肿瘤行剜除术与根治性胰切除术的适应证和结局。

Indications and outcomes of enucleation versus formal pancreatectomy for pancreatic neuroendocrine tumors.

机构信息

Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W 10th Ave, OH 43210, Columbus, USA; Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.

Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W 10th Ave, OH 43210, Columbus, USA.

出版信息

HPB (Oxford). 2021 Mar;23(3):413-421. doi: 10.1016/j.hpb.2020.06.015. Epub 2020 Aug 6.

DOI:10.1016/j.hpb.2020.06.015

PMID:32771338

Abstract

BACKGROUND

Pancreatoduodenectomy (PD) or distal pancreatectomy (DP) are common procedures for patients with a pancreatic neuroendocrine tumor (pNET). Nevertheless, certain patients may benefit from a pancreas-preserving resection such as enucleation (EN). The aim of this study was to define the indications and differences in long-term outcomes among patients undergoing EN and PD/DP.

METHODS

Patients undergoing resection of a pNET between 1992 and 2016 were identified. Indications and outcomes were evaluated, and propensity score matching (PSM) analysis was performed to compare long-term outcomes between patients who underwent EN versus PD/DP.

RESULTS

Among 1034 patients, 143 (13.8%) underwent EN, 304 (29.4%) PD, and 587 (56.8%) DP. Indications for EN were small size (1.5 cm, IQR:1.0-1.9), functional tumors (58.0%) that were mainly insulinomas (51.7%). After PSM (n = 109 per group), incidence of postoperative pancreatic fistula (POPF) grade B/C was higher after EN (24.5%) compared with PD/DP (14.0%) (p = 0.049). Median recurrence-free survival (RFS) was comparable among patients who underwent EN (47 months, 95% CI:23-71) versus PD/DP (37 months, 95% CI: 33-47, p = 0.480).

CONCLUSION

Comparable long-term outcomes were noted among patients who underwent EN versus PD/DP for pNET. The incidence of clinically significant POPF was higher after EN.

摘要

背景

胰十二指肠切除术（PD）或胰尾部切除术（DP）是治疗胰腺神经内分泌肿瘤（pNET）患者的常见手术方法。然而，某些患者可能受益于保留胰腺的切除术，如肿瘤剜除术（EN）。本研究旨在明确接受 EN 与 PD/DP 治疗的患者的适应证和长期预后差异。

方法

本研究回顾性分析了 1992 年至 2016 年间接受 pNET 切除术的患者。评估了患者的适应证和结局，并进行倾向评分匹配（PSM）分析，以比较接受 EN 与 PD/DP 治疗的患者的长期结局。

结果

在 1034 例患者中，有 143 例（13.8%）接受了 EN，304 例（29.4%）接受了 PD，587 例（56.8%）接受了 DP。EN 的适应证为肿瘤体积小（1.5cm，IQR：1.0-1.9cm）、功能性肿瘤（58.0%），主要为胰岛素瘤（51.7%）。PSM 后（每组 n=109），EN 后术后胰瘘（POPF）分级 B/C 的发生率（24.5%）高于 PD/DP（14.0%）（p=0.049）。接受 EN 与 PD/DP 治疗的患者的无复发生存期（RFS）中位数相似（EN：47 个月，95%CI：23-71；PD/DP：37 个月，95%CI：33-47，p=0.480）。