Li Cheng-Peng, Wang Zhen, Liu Bo-Nan, Lv Ang, Liu Dao-Ning, Wu Jian-Hui, Qiu Hui, Hao Chun-Yi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China.
Front Oncol. 2020 Sep 23;10:548789. doi: 10.3389/fonc.2020.548789. eCollection 2020.
En bloc resection of retroperitoneal sarcoma (RPS) with adjacent organs such as pancreatic head and duodenum is challenging for surgeons. This mono-institutional study aims to evaluate the feasibility, safety, and outcome of performing pancreaticoduodenectomy (PD) during RPS resection.
The clinical data of RPS patients who underwent PD at the Sarcoma Center of Peking University Cancer Hospital from January 2011 to December 2019 was collected and analyzed.
Twenty-seven patients out of a total of 264 surgically treated RPS underwent PD. The main pathological subtype was liposarcoma. All patients received concomitant resection of a median of three additional organs (range: 1-5), including 11 patients (40.7%) who underwent inferior vena cava resection and one patient who underwent segmental superior mesenteric-portal vein resection. Microscopic tumor infiltration to the duodenum or pancreas was observed in 81.5% of patients. Major complications occurred in 40.7% of patients; the reoperation rate was 22.2%. One patient (3.7%) died from liver abscess postoperatively. During a median follow-up of 18.9 months, 15 patients (55.6%) developed locally recurrent disease; two patients (7.4%) also had pulmonary metastases additionally. Twelve patients (44.4%) died from local relapse eventually.
PD during RPS resection is feasible, and it may be necessary to achieve complete resection. However, considering the complexity and risk, it should be performed by an experienced surgical team. The long-term survival benefit of this procedure should be verified by further large-scale multi-institutional studies.
整块切除腹膜后肉瘤（RPS）及相邻器官如胰头和十二指肠对外科医生来说具有挑战性。这项单中心研究旨在评估在RPS切除术中进行胰十二指肠切除术（PD）的可行性、安全性和结果。
收集并分析2011年1月至2019年12月在北京大学肿瘤医院肉瘤中心接受PD的RPS患者的临床资料。
在总共264例接受手术治疗的RPS患者中，有27例接受了PD。主要病理亚型为脂肪肉瘤。所有患者均同时切除了中位数为3个额外器官（范围：1 - 5个），其中11例（40.7%）患者接受了下腔静脉切除术，1例患者接受了肠系膜上静脉 - 门静脉节段切除术。81.5%的患者观察到肿瘤镜下浸润至十二指肠或胰腺。40.7%的患者发生了严重并发症；再次手术率为22.2%。1例患者（3.7%）术后死于肝脓肿。在中位随访18.9个月期间，15例患者（55.6%）出现局部复发性疾病；2例患者（7.4%）还伴有肺转移。12例患者（44.4%）最终死于局部复发。
RPS切除术中的PD是可行的，且可能有必要实现完整切除。然而，考虑到其复杂性和风险，应由经验丰富的手术团队进行。该手术的长期生存获益应通过进一步的大规模多中心研究来验证。
