Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Br J Surg. 2021 Apr 30;108(4):427-434. doi: 10.1093/bjs/znaa143.
Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences.
This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed.
Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM.
Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.
胰十二指肠切除术后壶腹周围癌复发较为常见。本研究旨在探讨复发模式、发生率以及与局部和远处复发相关的因素。
本回顾性单中心研究纳入了 2012 年 1 月至 2018 年 1 月期间接受根治性切除术的壶腹周围癌连续患者。分析了生存情况、复发模式以及与复发相关的因素。
398 例纳入患者的中位总生存（OS）和无病生存分别为 58.4 个月和 49.5 个月。23 例（5.8%）患者发生孤立性局部复发（LR），50 例（12.6%）患者发生 LR 伴远处转移（DM），103 例（25.9%）患者发生孤立性 DM。孤立性 LR 患者的中位 OS 为 40.4 个月，DM 患者为 23 个月（P<0.001）。肿瘤亚型（远端胆总管（CBD）：优势比（OR）6.18，95%置信区间（CI）2.19 至 17.46）和淋巴结阳性状态（OR 2.36，1.26 至 4.43）与 LR 发生率较高独立相关。孤立性 LR 最常见的部位是肠系膜上动脉（23 例中的 12 例）。肿瘤亚型（远端 CBD：OR 2.86，1.09 至 7.52）、淋巴结阳性（OR 2.46，1.53 至 3.94）和神经周围侵犯（OR 1.80，1.02 至 3.18）与 DM 独立相关。
孤立性 LR 与 DM 相比具有更好的生存结果，并且最常发生在肠系膜上动脉。
