Kim Kyeong Deok, Lee Kyo Won, Lee Ji Eun, Hwang Jeong Ah, Jo Sung Jun, Kim Jinseob, Lim So Hee, Park Jae Berm
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea.
Front Oncol. 2021 Dec 20;11:792943. doi: 10.3389/fonc.2021.792943. eCollection 2021.
En bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). However, resection of the pancreas is controversial because it may cause serious complications, such as pancreatic fistula or bleeding. Thus, we evaluated the outcomes of distal pancreatectomy (DP) in pancreas-abutting RPS of the left upper quadrant (LUQ).
We reviewed all consecutive patients who underwent surgery for RPS between September 2001 and April 2020. We selected 150 patients with all or part of their tumor located in the LUQ on preoperative computed tomography. Eighty-six patients who had tumors abutting the pancreas were finally enrolled in our study.
Fifty-three patients (53/86; 61.6%) were included in the non-DP group, and 33 patients (33/86; 38.4%) were included in the DP group. Total postoperative complications and complication rates for those Clavien-Dindo grade 3 or higher were similar between the non-DP group and DP group (p = 0.290 and p = 0.550). In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients. During multivariate analysis, microscopic pancreatic invasion was deemed a risk factor for local recurrence (p = 0.029). However, there were no significant differences on preoperative computed tomography findings between the pancreatic invasion and non-invasion groups.
DP is a reasonable procedure for pancreas-abutting RPS located at the LUQ when both complications and complete resection are considered.
对于局限性腹膜后肉瘤（RPS），建议将肿瘤与相邻器官整块切除。然而，胰腺切除术存在争议，因为它可能导致严重并发症，如胰瘘或出血。因此，我们评估了左上腹（LUQ）毗邻胰腺的RPS行胰体尾切除术（DP）的疗效。
我们回顾了2001年9月至2020年4月期间所有连续接受RPS手术的患者。我们选择了150例术前计算机断层扫描显示全部或部分肿瘤位于LUQ的患者。最终，86例肿瘤毗邻胰腺的患者纳入我们的研究。
非DP组纳入53例患者（53/86；61.6%），DP组纳入33例患者（33/86；38.4%）。非DP组和DP组术后总并发症及Clavien-Dindo 3级或更高等级并发症发生率相似（p = 0.290和p = 0.550）。DP组中，18.2%（6/33）的患者发生B级胰瘘，但无C级胰瘘，42.4%（14/33）的患者存在显微镜下胰腺侵犯。多因素分析时，显微镜下胰腺侵犯被认为是局部复发的危险因素（p = 0.029）。然而，胰腺侵犯组和未侵犯组术前计算机断层扫描结果无显著差异。
当同时考虑并发症和完整切除时，DP是治疗LUQ毗邻胰腺的RPS的合理术式。
