Shao Yi, Feng Jiaojiao, Hu Zhenhua, Wu Jian, Zhang Min, Shen Yan, Zheng Shusen
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.
Ann Med Surg (Lond). 2020 Nov 13;62:490-494. doi: 10.1016/j.amsu.2020.11.037. eCollection 2021 Feb.
Resection of pancreatic ductal adenocarcinoma (PDAC) with synchronous liver metastasectomy is still a matter of debate. We aimed to evaluate the feasibility of synchronous resection of PDAC and liver metastases for curative intent at a high-volume surgical center.
Patients who underwent pancreaticoduodenectomy (PD) with synchronous liver metastasectomy (M1 resection group, n = 50) were matched 1 : 1 based on tumor and nodular stage, age, gender, body mass index and concomitant disease with two control groups (M0 resection and M1 no resection). The M0 resection group included patients who underwent PD without metastases. The M1 no resection group included patients with liver metastases who underwent palliative bypass or exploratory laparotomy without resection followed by palliative and adjuvant therapies.
M1 resection group had a longer operation time, larger intraoperative blood loss, and longer postoperative hospital stay than other two groups. R0 resection rate of M1 resection group was similar to that of M0 resection group (92% vs. 94%, p = 1.000). Postoperative complications were comparable between the groups. The overall median survival in M1 resection, M0 resection, and M1 no resection group was 16, 30, and 6 months, respectively. Cumulative survival rates for 1-, 2-, and 3-year of the M1 resection, M0 resection, and M1 no resection group were 63.8%, 29.0%, and 6.7%; 94.0%, 74.4%, and 25.1%; 24.0%, 2.0%, and 0%, respectively. The survival of M1 resection group was worse than that of M0 resection group (p = 0.009), however significantly much better than that of M1 no resection group (p = 0.001). Univariate analysis showed carcinoembryonic antigen >8 ng/ml and non-R0 resection were associated with death. Multivariate analysis revealed that M1 resection group had improved survival compared with M1 no resection group.
PD with synchronous liver metastasectomy for oligometastatic PDAC is safe and feasible, it might provide survival benefits for selected patients.
同步肝转移瘤切除术治疗胰腺导管腺癌（PDAC）仍存在争议。我们旨在评估在一个大型手术中心同步切除PDAC和肝转移瘤以达到治愈目的的可行性。
接受胰十二指肠切除术（PD）并同步进行肝转移瘤切除术的患者（M1切除组，n = 50），根据肿瘤和结节分期、年龄、性别、体重指数及合并疾病，与两个对照组（M0切除组和M1未切除组）进行1:1匹配。M0切除组包括未发生转移而接受PD的患者。M1未切除组包括有肝转移但接受姑息性旁路手术或未行切除的探查性剖腹手术，随后接受姑息治疗和辅助治疗的患者。
M1切除组的手术时间更长、术中失血量更大、术后住院时间更长。M1切除组的R0切除率与M0切除组相似（92%对94%，p = 1.000）。各组术后并发症相当。M1切除组、M0切除组和M1未切除组的总体中位生存期分别为16个月、30个月和6个月。M1切除组、M0切除组和M1未切除组1年、2年和3年的累积生存率分别为63.8%、29.0%和6.7%；94.0%、74.4%和25.1%；24.0%、2.0%和0%。M1切除组的生存率低于M0切除组（p = 0.009），但明显高于M1未切除组（p = 0.001）。单因素分析显示癌胚抗原>8 ng/ml和非R0切除与死亡相关。多因素分析显示，与M1未切除组相比，M1切除组的生存率有所提高。
对于寡转移PDAC，同步肝转移瘤切除术治疗PD是安全可行的，可能为部分患者带来生存获益。
