Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
Pancreatology. 2022 Jan;22(1):112-122. doi: 10.1016/j.pan.2021.11.001. Epub 2021 Nov 3.
Whether coeliac axis resection (CAR) results from tumour topography or a prognostic factor for distal pancreatic ductal adenocarcinoma (PDAC) remains unclear. We aimed to compare the clinicopathological data between distal pancreatectomy with en bloc CAR (DP-CAR) and distal pancreatectomy plus splenectomy (DP-S) and analyse the prognostic factors.
We retrospectively analysed clinicopathological data from 102 patients who underwent distal pancreatectomy for PDAC and the factors affecting disease-free survival (DFS) and overall survival (OS). Of these patients, 45 and 57 underwent DP-CAR and DP-S, respectively.
DP-CAR was associated with more operative challenges than DP-S: more portomesenteric vein resections (48.9% vs. 14.0%), longer operations (320 vs. 242 min), and greater estimated blood loss (EBL) (600 vs. 200 ml). DP-CAR had larger tumours (5 vs. 4 cm), more perineural invasion (91.1% vs. 73.7%), and more microscopically positive surgical margins (20% vs. 3.5%), compared to DP-S. The major complication was clinically relevant postoperative pancreatic fistula (20.6%). The median DFS was 15.8 months and the median OS was 20.1 months. CAR was not associated with DFS or OS. EBL>700 ml, lymphovascular invasion (LVI), and adjuvant chemotherapy independently affected DFS and OS.
DP-CAR was associated with larger tumours and more surgical challenges but not with poorer DFS and OS than DP-S. CAR was more likely to result from tumour topography rather than from an adverse prognostic factor for resected distal PDAC. EBL>700 ml, LVI, and adjuvant chemotherapy were independent factors affecting the survival of patients with distal PDAC who underwent surgical resection.
空肠主干切除术（CAR）是由于肿瘤位置所致，还是远端胰腺导管腺癌（PDAC）的预后因素尚不清楚。我们旨在比较整块胰尾切除术伴 CAR（DP-CAR）和胰尾切除术加脾切除术（DP-S）的临床病理数据，并分析其预后因素。
我们回顾性分析了 102 例接受 PDAC 远端胰腺切除术的患者的临床病理资料，以及影响无病生存（DFS）和总生存（OS）的因素。其中 45 例患者行 DP-CAR，57 例行 DP-S。
与 DP-S 相比，DP-CAR 手术更具挑战性：更多的门静脉肠系膜切除术（48.9%比 14.0%）、更长的手术时间（320 分钟比 242 分钟）和更大的估计出血量（EBL）（600 毫升比 200 毫升）。与 DP-S 相比，DP-CAR 的肿瘤更大（5 厘米比 4 厘米），神经周围侵犯更多（91.1%比 73.7%），显微镜下阳性切缘更多（20%比 3.5%）。主要并发症为临床相关的术后胰瘘（20.6%）。中位 DFS 为 15.8 个月，中位 OS 为 20.1 个月。CAR 与 DFS 或 OS 无关。EBL>700ml、脉管侵犯（LVI）和辅助化疗是影响 DFS 和 OS 的独立因素。
与 DP-S 相比，DP-CAR 与更大的肿瘤和更多的手术挑战相关，但与 DP-S 相比，DFS 和 OS 无差异。CAR 更可能是由于肿瘤位置所致，而不是切除的远端 PDAC 的不良预后因素。EBL>700ml、LVI 和辅助化疗是接受手术切除的远端 PDAC 患者生存的独立因素。
