整块肠系膜上动脉周围淋巴结清扫术改善了 T3 型胰导管腺癌动脉优先胰十二指肠切除术的生存预后。

Complete Lymphadenectomy Around the Entire Superior Mesenteric Artery Improves Survival in Artery-First Approach Pancreatoduodenectomy for T3 Pancreatic Ductal Adenocarcinoma.

机构信息

Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.

Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan.

出版信息

World J Surg. 2021 Mar;45(3):857-864. doi: 10.1007/s00268-020-05856-w. Epub 2020 Nov 10.

DOI:10.1007/s00268-020-05856-w

PMID:33174091

Abstract

BACKGROUND

Artery-first approach pancreatoduodenectomy (AFA-PD) is an important technique for treating pancreatic ductal adenocarcinoma (PDAC). However, it remains unknown whether performing complete lymphadenectomy around the entire superior mesenteric artery (SMA) is associated with better outcomes. In this retrospective study, we aimed to investigate whether this approach improved overall and recurrence-free survival in patients with PDAC.

METHODS

We identified 88 patients with T3 PDAC who underwent PD at St. Marianna University School of Medicine, Kawasaki, Japan, between April 2005 and October 2017. Two groups were defined: an "AFA-PD group" (n = 45) who had undergone AFA-PD in addition to complete lymphadenectomy around the entire SMA, and a "conventional PD group" (n = 43) in whom complete lymphadenectomy had not been performed (conventional group). Univariate and multivariate survival analyses were performed to identify risk factors for overall and disease-free survival.

RESULTS

The AFA-PD group had a longer median survival time (40.3 vs. 22.6 months; p = 0.0140) and a higher 5-year survival rate (40.3% vs. 5.9%, p = 0.005) than the conventional PD group. Multivariate analysis showed that AFA-PD with complete lymphadenectomy around the entire SMA was an independent factor for improved overall survival (p = 0.022). Recurrences around the SMA were significantly less frequent in the AFA-PD group than in the conventional group (22.2% vs. 44.2%, p = 0.041).

CONCLUSIONS

AFA-PD with complete lymphadenectomy around the entire SMA can prevent recurrences around the SMA and may prolong overall survival in patients with PDAC.

摘要

背景

动脉优先胰十二指肠切除术（AFA-PD）是治疗胰腺导管腺癌（PDAC）的重要技术。然而，围绕整个肠系膜上动脉（SMA）进行完整的淋巴结清扫术是否会带来更好的结果仍不清楚。在这项回顾性研究中，我们旨在研究这种方法是否改善了 PDAC 患者的总生存率和无复发生存率。

方法

我们在日本川崎圣玛丽安娜医科大学鉴定了 2005 年 4 月至 2017 年 10 月期间接受 PD 的 88 例 T3 PDAC 患者。将他们分为两组：一组为“动脉优先胰十二指肠切除术组（AFA-PD 组）”（n=45），他们除了在整个 SMA 周围进行完整的淋巴结清扫术外，还进行了 AFA-PD；另一组为“常规胰十二指肠切除术组（conventional PD 组）”（n=43），他们未进行完整的淋巴结清扫术（conventional 组）。我们进行了单因素和多因素生存分析，以确定总生存率和无病生存率的危险因素。

结果

AFA-PD 组的中位生存时间（40.3 个月 vs. 22.6 个月；p=0.0140）和 5 年生存率（40.3% vs. 5.9%；p=0.005）均高于 conventional PD 组。多因素分析表明，在整个 SMA 周围进行 AFA-PD 伴完整的淋巴结清扫术是改善总生存率的独立因素（p=0.022）。AFA-PD 组 SMA 周围的复发明显少于 conventional 组（22.2% vs. 44.2%；p=0.041）。