Ratnayake Bathiya, Al-Leswas Dhya, Mohammadi-Zaniani Ghazaleh, Littler Peter, Sen Gourab, Manas Derek, Pandanaboyana Sanjay
Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
Hepato-Pancreato-Biliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.
Cancers (Basel). 2021 Jun 27;13(13):3212. doi: 10.3390/cancers13133212.
The present systematic review aimed to summarise the available evidence on indications and oncological outcomes after MA IRE for stage III pancreatic cancer (PC). A literature search was performed in the Pubmed, MEDLINE, EMBASE, SCOPUS databases using the PRISMA framework to identify all MA IRE studies. Nine studies with 235 locally advanced (LA) (82%, 192/235) or Borderline resectable (BR) PC (18%, 43/235) patients undergoing MA IRE pancreatic resection were included. Patients were mostly male (56%) with a weighted-mean age of 61 years (95% CI: 58-64). Pancreatoduodenectomy was performed in 51% (120/235) and distal pancreatectomy in 49% (115/235). R0 resection rate was 73% (77/105). Clavien Dindo grade 3-5 postoperative complications occurred in 19% (36/187). Follow-up intervals ranged from 3 to 29 months. Local and systematic recurrences were noted in 8 and 43 patients, respectively. The weighted-mean progression free survival was 11 months (95% CI: 7-15). The weighted-mean overall survival was 22 months (95% CI 20-23 months) and 8 months (95% CI 1-32 months) for MA IRE and IRE alone, respectively. Early non-randomised data suggest MA IRE during pancreatic surgery for stage III pancreatic cancer may result in increased R0 resection rates and improved OS with acceptable postoperative morbidity. Further, larger studies are warranted to corroborate this evidence.
本系统评价旨在总结关于局部晚期胰腺癌（PC）进行术中微波消融（MA IRE）后的适应证及肿瘤学结局的现有证据。使用PRISMA框架在Pubmed、MEDLINE、EMBASE、SCOPUS数据库中进行文献检索，以识别所有MA IRE研究。纳入了9项研究，共235例接受MA IRE胰腺切除术的局部晚期（LA）（82%，192/235）或边缘可切除（BR）PC（18%，43/235）患者。患者大多为男性（56%），加权平均年龄为61岁（95%CI：58 - 64）。51%（120/235）的患者接受了胰十二指肠切除术，49%（115/235）的患者接受了远端胰腺切除术。R0切除率为73%（77/105）。19%（36/187）的患者发生了Clavien Dindo 3 - 5级术后并发症。随访时间为3至29个月。分别有8例和43例患者出现局部和全身复发。加权平均无进展生存期为11个月（95%CI：7 - 15）。MA IRE和单纯IRE的加权平均总生存期分别为22个月（95%CI 20 - 23个月）和8个月（95%CI 1 - 32个月）。早期非随机数据表明，对于III期胰腺癌患者，术中进行MA IRE可能会提高R0切除率并改善总生存期，且术后发病率可接受。此外，需要更大规模的研究来证实这一证据。
