Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
J Surg Oncol. 2022 Nov;126(6):1038-1047. doi: 10.1002/jso.27003. Epub 2022 Jul 7.
Extrapancreatic nerve plexus (PL) invasion of pancreatic ductal adenocarcinoma (PDAC) is an important factor for determining resectability and surgical method. We sought to clarify the characteristics of PDAC with PL invasion and clinical impact of the resection margin status on prognosis for PDAC with PL invasion.
A total of 242 patients with pancreatic head cancer who underwent pancreatectomy were evaluated. Clinicopathological data and patient survival were analyzed.
Pathological PL invasion was observed in 68 patients (28.1%). Patients with PL invasion had significantly shorter disease-free survival (DFS) and showed trends toward worse overall survival (OS) than those without PL invasion. While multivariate analysis revealed that PL invasion was not an independent prognostic factor, PL invasion was associated with extensive venous invasion and a high percentage of lymph node metastases, both of which were independent factors affecting DFS and OS. Among patients with PL invasion, there was no significant difference in DFS and OS between the R0 and R1 resection groups.
PL invasion is a common pathological feature of aggressive PDAC with high propensity for invasiveness and metastatic potential. The microscopic resection margin status may not affect the survival of pancreatic head cancer patients with PL invasion.
胰外神经丛（PL）侵犯胰腺导管腺癌（PDAC）是决定可切除性和手术方法的重要因素。我们旨在阐明伴有 PL 侵犯的 PDAC 的特征，以及 PL 侵犯的切缘状态对伴有 PL 侵犯的 PDAC 预后的临床影响。
共评估了 242 例接受胰头切除术的胰腺癌患者。分析了临床病理数据和患者生存情况。
68 例（28.1%）患者存在病理性 PL 侵犯。PL 侵犯患者的无病生存期（DFS）明显更短，且总体生存期（OS）也呈恶化趋势，与无 PL 侵犯患者相比。多因素分析显示，PL 侵犯不是独立的预后因素，但与广泛的静脉侵犯和高比例的淋巴结转移有关，这两者都是影响 DFS 和 OS 的独立因素。在伴有 PL 侵犯的患者中，R0 和 R1 切除组之间的 DFS 和 OS 无显著差异。
PL 侵犯是具有侵袭性和转移潜能的侵袭性 PDAC 的常见病理特征。微观切缘状态可能不会影响伴有 PL 侵犯的胰头癌患者的生存。
