Huang X M, Yin J, Lu Z P, Chen J M, Cai B B, Wu P F, Jiang K R, Miao Y
Pancreas Center,First Affiliated Hospital of Nanjing Medical University,Pancreas Institute,Nanjing Medical University,Nanjing 210029,China.
Zhonghua Wai Ke Za Zhi. 2022 May 1;60(5):441-448. doi: 10.3760/cma.j.cn112139-20210824-00390.
To compare the outcomes of modified Appleby procedure and sub-adventitial divestment technique for locally advanced or borderline resectable pancreatic body cancer. A total of consecutive 58 patients(33 males and 25 females) who were diagnosed as locally advanced or borderline resectable pancreatic body cancer and underwent distal pancreatectomy at Pancreas Center, First Affiliated Hospital of Nanjing Medical University between September 2013 and May 2019 were retrospectively reviewed. The age((IQR)) was 62(9)years(range: 43 to 79 years). Thirty-one patients underwent distal pancreatectomy with celiac axis resection (DP-CAR) and 27 patients underwent distal pancreatectomy with sub-adventitial divestment technique(SDT). Perioperative parameters and follow-up data of these patients were analyzed. Quantitative data were compared with Wilcoxon test while categorical variables were compared with χ test or Fisher's exact test. Survival results were estimated by the Kaplan-Meier survival method with a Log-rank test. There were no differences in age,gender,body mass index,abdominal symptoms,comorbidity or preoperative serum CA19-9 between two groups(all >0.05). Obvious preoperative weight loss was more common in the group of SDT(48.1%(13/27) 19.4%(6/31),χ²=5.431,=0.020). Longer operative time(310(123) minutes . 254(137)minutes, =2.277,=0.023),higher rate of combined organ resection(41.9%(13/31) 14.8%(4/27),χ²=5.123,=0.041) and longer postoperative hospital stay(15(10) days 11(5)days,=2.292,=0.022) were observed in the group of DP-CAR. Moreover,rate of overall morbidities was also higher (71.0%(22/31) 29.6%(8/27),χ=9.876,=0.003),implicated by clinically relevant postoperative pancreatic fistula(61.3%(19/31) 29.6%(8/27),χ=5.814,=0.020) in the DP-CAR group. Tumor size of the DP-CAR group was bigger(4.9(1.5)cm 4.0(1.2)cm,=2.343,=0.019) but no difference was seen between the DP-CAR group and SDT group in R0+R1(<1 mm) resection rate (84.0%(21/25) 90.0%(18/20),=0.678) and LNR(12.0(23.0)% . 9.0(18.0)%,=1.238,=0.216),as well as median disease free survival(11.7 months 11.4 months,=0.019,=0.892) and median overall survival(16.3 months 13.7 months,=0.172,=0.679). Both DP-CAR and distal pancreatectomy with SDT are relatively safe and feasible for locally advanced or borderline resectable pancreatic body cancer. Compared with arterial resection,SDT may contribute to lower rates of postoperative complications and shorter duration of hospitalization,but no significant benefit is seen in long-term survival.
比较改良Appleby手术和外膜下剥离技术治疗局部进展期或交界可切除胰体癌的疗效。回顾性分析2013年9月至2019年5月在南京医科大学第一附属医院胰腺中心诊断为局部进展期或交界可切除胰体癌并接受胰体尾切除术的58例连续患者（男性33例，女性25例）。年龄（四分位间距）为62（9）岁（范围：43至79岁）。31例行联合腹腔干切除的胰体尾切除术（DP-CAR），27例行外膜下剥离技术的胰体尾切除术（SDT）。分析这些患者的围手术期参数和随访数据。定量数据采用Wilcoxon检验进行比较，分类变量采用χ检验或Fisher精确检验进行比较。生存结果采用Kaplan-Meier生存法和Log-rank检验进行估计。两组患者在年龄、性别、体重指数、腹部症状、合并症或术前血清CA19-9方面均无差异（均>0.05）。术前明显体重减轻在SDT组更常见（48.1%（13/27）对19.4%（6/31），χ²=5.431，P=0.020）。DP-CAR组手术时间更长（310（123）分钟对254（137）分钟，t=2.277，P=0.023），联合器官切除率更高（41.9%（13/31）对14.8%（4/27），χ²=5.123，P=0.041），术后住院时间更长（15（10）天对11（5）天，t=2.292，P=0.022）。此外，DP-CAR组总体并发症发生率也更高（71.0%（22/31）对29.6%（8/27），χ²=9.876，P=0.003），临床相关的术后胰瘘发生率更高（61.3%（19/31）对29.6%（8/27），χ²=5.814，P=0.020）。DP-CAR组肿瘤更大（4.9（1.5）cm对4.0（1.2）cm，t=2.343，P=0.019），但DP-CAR组和SDT组在R0+R1（<1mm）切除率（84.0%（21/25）对90.0%（18/20），z=0.678）、淋巴结转移率（12.0（23.0）%对9.0（18.0）%，z=1.238，P=0.216）以及无病生存期中位数（11.7个月对11.4个月，z=0.019，P=0.892）和总生存期中位数（16.3个月对13.7个月，z=0.172，P=0.679）方面无差异。DP-CAR和SDT胰体尾切除术对于局部进展期或交界可切除胰体癌均相对安全可行。与动脉切除相比，SDT可能有助于降低术后并发症发生率和缩短住院时间，但在长期生存方面未观察到显著益处。
