Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Surg Oncol. 2022 Mar;125(4):642-645. doi: 10.1002/jso.26781. Epub 2022 Jan 11.
For patients with periampullary adenocarcinoma (PAC), pancreatoduodenectomy (PD) provides the best survival. Surgery on a subset of patients is aborted during PD. We analyzed these patients.
Patients who underwent laparotomy for planned PD for PAC were identified (2006-2019). From operative notes, we identified the subset with intraoperative decision to abort. Patient, treatment, and outcome data were analyzed. The subset with pancreatic ductal adenocarcinoma (PDAC) was analyzed for survival.
Only 6.7% (n = 55/819) of cases were aborted. Majority 78% (n = 43) had pathologically-confirmed diagnoses at time of surgery, and 18.2% (n = 10) received preoperative chemotherapy. Reasons for aborted PD included: distant metastases (65.5%, n = 36) and local invasion (34.5%, n = 19). Of patients with metastatic disease, 75% (n = 27) had liver metastases. Eighty-nine percent (n = 49) of patients underwent at least one palliative bypass procedure and 81.8% (n = 45) had both gastric and biliary bypass. Patients with computed tomography (CT) scans before surgery more commonly had missed metastatic disease (79.2% CT compared to 54.8% magnetic resonance imaging [MRI], χ = 3.54, p = 0.059). In PDAC, 61.4% (n = 27/44) were aborted for metastatic disease and 38.7% (n = 17/44) for local invasion. Median overall survival for all PDAC patients after aborted PD was 334 days.
Majority of pancreatoduodenectomies for periampullary adenocarcinoma are done to completion. Liver metastases is the most common reason for aborting. Preoperative MRI may help identify hepatic metastases.
对于壶腹周围腺癌（PAC）患者，胰十二指肠切除术（PD）是提供最佳生存的方法。但在部分患者中，PD 手术会被中止。我们对这些患者进行了分析。
确定了 2006 年至 2019 年期间因计划行 PD 而接受剖腹手术的 PAC 患者。从手术记录中，我们确定了术中决定中止手术的亚组。分析了该亚组患者的治疗和结局数据。对胰腺导管腺癌（PDAC）患者进行了生存分析。
只有 6.7%（n=55/819）的病例被中止。大多数患者（78%，n=43）在手术时病理诊断为 PDAC，18.2%（n=10）接受了术前化疗。中止 PD 的原因包括：远处转移（65.5%，n=36）和局部侵犯（34.5%，n=19）。有转移病灶的患者中，75%（n=27）有肝转移。89%（n=49）的患者至少接受了一次姑息性旁路手术，81.8%（n=45）同时进行胃和胆道旁路。术前进行 CT 扫描的患者更常见的是遗漏了转移性疾病（CT 检查为 79.2%，MRI 检查为 54.8%，χ²=3.54，p=0.059）。在 PDAC 中，61.4%（n=27/44）因转移性疾病中止手术，38.7%（n=17/44）因局部侵犯中止手术。所有中止 PD 的 PDAC 患者的中位总生存期为 334 天。
大多数因 PAC 而行 PD 手术均能完成。肝转移是中止手术的最常见原因。术前 MRI 可能有助于发现肝转移。
