Jin Peng, Liu Hao, Ma Fu-Hai, Ma Shuai, Li Yang, Xiong Jian-Ping, Kang Wen-Zhe, Hu Hai-Tao, Tian Yan-Tao
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
World J Clin Cases. 2021 Oct 16;9(29):8718-8728. doi: 10.12998/wjcc.v9.i29.8718.
For advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial.
To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.
A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients.
There were 24 patients (16.8%) in the GP group who had significantly larger lesions ( < 0.001), a higher incidence of advanced N stage ( = 0.030), and less neoadjuvant chemotherapy ( < 0.001) than the GA group had. Postoperative morbidity (33.3% 15.3%, = 0.128) and mortality (4.2% 4.8%, = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo 20.4%, median 22.8 mo, = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103-0.821, = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024-6.675, = 0.033), surgical margin (HR 0.274, 95% CI: 0.102-0.738, = 0.010), N stage (HR 3.489, 95% CI: 1.334-9.120, = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163-0.836, = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion.
Curative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.
对于伴有胰头侵犯的进展期胃癌患者，一些研究表明扩大多器官切除术（EMR）可提高生存率。然而，其他报告显示EMR术后发病率和死亡率较高。T4b期胃癌的EMR仍存在争议。
评估伴有胰头侵犯的pT4b期胃癌的手术方式。
2006年至2016年期间，在中国国家癌症中心对144例连续的伴有胰头侵犯的胃癌患者进行了手术治疗。76例患者术后病理确诊为胃癌，并进行回顾性分析。通过比较这些患者的临床病理特征、手术结果和预后因素，将患者分为胃切除术加胰十二指肠切除术组（GP组）和单纯胃切除术组（GA组）。
GP组有24例患者（16.8%），与GA组相比，其病变明显更大（<0.001），晚期N分期发生率更高（=0.030），新辅助化疗更少（<0.001）。GP组和GA组术后发病率（33.3%对15.3%，=0.128）和死亡率（4.2%对4.8%，=1.000）无显著差异。GP组患者的总体3年生存率明显长于GA组（47.6%，中位30.3个月对20.4%，中位22.8个月，=0.010）。多因素分析确定新辅助化疗[风险比（HR）0.290，95%置信区间（CI）：0.103 - 0.821，=0.020]、皮革胃（HR 2.614，95%CI：1.024 - 6.675，=0.033）、手术切缘（HR 0.274，95%CI：0.102 - 0.738，=0.010）、N分期（HR 3.489，95%CI：1.334 - 9.120，=0.011）和术后放化疗（HR 0.369，95%CI：0.163 - 0.836，=0.017）是pT4b期胃癌伴胰头侵犯患者生存的独立预测因素。
对于选定的患者，应进行受累胰腺的根治性切除以提高生存率。胰头侵犯并非手术禁忌证。
