Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Br J Surg. 2021 Dec 17;109(1):105-113. doi: 10.1093/bjs/znab357.
Major vessel invasion is an important factor for determining the surgical approach and long-term prognosis for patients with pancreatic head cancer. However, clinical implications of vessel invasion have seldom been reported in pancreatic body or tail cancer. This study aimed to evaluate the clinical relevance of splenic vessel invasion with pancreatic body or tail cancer compared with no invasion and investigate prognostic factors.
This study enrolled patients who underwent upfront distal pancreatectomy from 2005 to 2018. The circular degree of splenic vessel invasion was investigated and categorized into three groups (group 1, no invasion; group 2, 0-180°; group 3, 180° or more). Clinicopathological variables and perioperative and survival outcomes were evaluated, and multivariable Cox proportional analysis was performed to evaluate prognostic factors.
Among 249 enrolled patients, tumour size was larger in patients with splenic vessel invasion (3.9 versus 2.9 cm, P = 0.001), but the number of metastatic lymph nodes was comparable to that in patients with no vessel invasion (1.7 versus 1.4, P = 0.241). The 5-year overall survival rates differed significantly between the three groups (group 1, 38.4 per cent; group 2, 16.8 per cent; group 3, 9.7 per cent, P < 0.001). Patients with both splenic artery and vein invasion had lower 5-year overall survival rates than those with one vessel (7.5 versus 20.2 per cent, P = 0.021). Cox proportional analysis revealed adjuvant treatment, R0 resection and splenic artery invasion as independent prognostic factors for adverse outcomes in pancreatic body or tail cancer.
Splenic vessel invasion was associated with higher recurrence and lower overall survival in pancreatic body or tail cancers suggesting a need for a neoadjuvant approach.
大血管侵犯是决定胰头癌手术方式和长期预后的重要因素。然而，血管侵犯对胰体尾癌的临床意义鲜有报道。本研究旨在评估胰体尾癌合并脾血管侵犯与无侵犯患者的临床相关性，并探讨预后因素。
本研究纳入了 2005 年至 2018 年间接受根治性胰体尾切除术的患者。研究调查了脾血管侵犯的圆周程度，并将其分为三组（组 1：无侵犯；组 2：0-180°；组 3：180°或更多）。评估了临床病理变量以及围手术期和生存结局，并进行了多变量 Cox 比例风险分析以评估预后因素。
在纳入的 249 名患者中，脾血管侵犯患者的肿瘤直径较大（3.9 厘米 vs. 2.9 厘米，P=0.001），但转移淋巴结数量与无血管侵犯患者相似（1.7 个 vs. 1.4 个，P=0.241）。三组间 5 年总生存率差异有统计学意义（组 1：38.4%；组 2：16.8%；组 3：9.7%，P<0.001）。同时侵犯脾动静脉的患者 5 年总生存率低于仅侵犯一条血管的患者（7.5% vs. 20.2%，P=0.021）。Cox 比例风险分析显示，辅助治疗、R0 切除和脾动脉侵犯是胰体尾癌不良预后的独立预后因素。
脾血管侵犯与胰体尾癌的高复发率和低总生存率相关，提示需要新辅助治疗。
