胰腺癌手术中的动脉切除：度过学习曲线后效果显著。

Arterial Resection in Pancreatic Cancer Surgery: Effective After a Learning Curve.

作者信息

Loos Martin, Kester Tobias, Klaiber Ulla, Mihaljevic André L, Mehrabi Arianeb, Müller-Stich Beat M, Diener Markus K, Schneider Martin A, Berchtold Christoph, Hinz Ulf, Feisst Manuel, Strobel Oliver, Hackert Thilo, Büchler Markus W

机构信息

Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.

Institute for Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany.

出版信息

Ann Surg. 2022 Apr 1;275(4):759-768. doi: 10.1097/SLA.0000000000004054.

DOI:10.1097/SLA.0000000000004054

PMID:33055587

Abstract

OBJECTIVE

To investigate the perioperative and oncologic long-term outcomes of patients with LAPC after surgical resection at a high-volume center for pancreatic surgery.

BACKGROUND

The role of surgery in LAPC with arterial involvement is controversial.

METHODS

We analyzed 385 consecutive patients undergoing PAR (n = 195) or PAD (n = 190) of the encased artery for LAPC between January 1, 2003 and April 30, 2019.

RESULTS

There were 183 total pancreatectomies, 113 partial pancreatoduodenectomies, 79 distal pancreatectomies, and 10 resections for tumor recurrences, including 121 multivisceral resections and 171 venous resections. Forty-three patients (11.4%) had resectable oligometastatic disease. All of the 190 patients undergoing PAD (100%) and 95 of the 195 patients undergoing PAR (48.7%) received neoadjuvant chemotherapy. The R0 (circumferential resection margin negative) resection rate was 28%. The median hospital stay was 15 days (range: 3-236). The median survival after surgery for LAPC was 20.1 months and the overall 5-year survival rate 12.5%. In-hospital mortality was 8.8% for the entire patient cohort (n = 385). With increasing case load and growing expertise, there was a significant reduction of in-hospital mortality to 4.8% (n = 186) after 2013 (P = 0.005). The learning curve of experienced pancreatic surgeons for PAR was 15 such procedures.

CONCLUSION

Our data demonstrate that an arterial surgical approach is effective in LAPC with promising long-term survival. PAD after neoadjuvant treatment is safe. PAR is a technically demanding procedure and requires a high level of expertise.

摘要

目的

在一家大型胰腺手术中心，研究接受手术切除的局部晚期胰腺癌（LAPC）患者的围手术期及肿瘤学长期预后。

背景

手术在伴有动脉受累的LAPC中的作用存在争议。

方法

我们分析了2003年1月1日至2019年4月30日期间连续接受包裹动脉的胰腺癌根治术（PAR，n = 195）或动脉旷置胰腺癌根治术（PAD，n = 190）的385例患者。

结果

共进行了183例全胰切除术、113例胰十二指肠切除术、79例胰体尾切除术以及10例肿瘤复发切除术，包括121例多脏器切除术和171例静脉切除术。43例患者（11.4%）有可切除的寡转移疾病。190例接受PAD的患者（100%）和195例接受PAR的患者中的95例（48.7%）接受了新辅助化疗。R0（切缘阴性）切除率为28%。中位住院时间为15天（范围：3 - 236天）。LAPC手术后的中位生存期为20.1个月，总体5年生存率为12.5%。整个患者队列（n = 385）的住院死亡率为8.8%。随着病例数量增加和专业技能提高，2013年后住院死亡率显著降至4.8%（n = 186）（P = 0.005）。经验丰富的胰腺外科医生进行PAR的学习曲线为15例此类手术。