Bartsch Detlef K, Windel Sebastian, Kanngießer Veit, Jesinghaus Moritz, Holzer Katharina, Rinke Anja, Maurer Elisabeth
Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany.
Institute of Pathology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany.
Cancers (Basel). 2022 Jul 25;14(15):3610. doi: 10.3390/cancers14153610.
The goal of primary tumor resection with lymphadenectomy (PTR) in small intestine neuroendocrine neoplasms (SI-NENs) is to avoid local recurrence while sparing as much of the small bowel as possible, even in the case of extensive mesenteric fibrosis. The results of PTR with retrograde vessel-sparing lymphadenectomy (VS-LA) were compared to those of conventional lymphadenectomy (Con-LA).
Prospectively collected clinical, surgical and pathological data of consecutive patients with SI-NENs who underwent small bowel resections were retrospectively analyzed regarding the resection technique performed.
In a 7-year period, 50 of 102 patients with SI-NENs had only small bowel resections; of those, 25 were VS-LA and 25 were Con-LA. Patients with VS-LA had tendentially more advanced diseases with slightly higher rates of abdominal pain, mesenteric shrinkage and more level III lymph node involvement compared to patients with Con-LA. VS-LA, however, resulted in shorter resected bowel segments (median 40 cm vs. 65 cm, = 0.007) with similar rates of local R0 resections (72% vs. 84%) and resected lymph nodes (median 13 vs. 13). Postoperative clinically relevant complications occurred in 1 of 25 (4%) in the VS-LA and in 7 of 25 (28%) patients in the Con-LA group ( = 0.02). Three months after surgery, 1 of 25 (4%) patients of the VS-LA group and 10 of 25 (40%) patients in the Con-LA group ( = 0.002) complained about abdominal pain. One of eight patients in the VS-LA group and two of thirteen patients in the Con-LA group who had completely resected stage III disease complained about diarrhea ( = 0.31).
VS-LA seems to be oncologically safe and should be considered in small bowel resections for SI-NENs.
小肠神经内分泌肿瘤（SI-NENs）行原发性肿瘤切除联合淋巴结清扫术（PTR）的目的是避免局部复发，同时尽可能保留更多的小肠，即使存在广泛的肠系膜纤维化。将逆行保留血管淋巴结清扫术（VS-LA）的PTR结果与传统淋巴结清扫术（Con-LA）的结果进行比较。
对前瞻性收集的连续接受小肠切除术的SI-NENs患者的临床、手术和病理数据进行回顾性分析，分析所采用的切除技术。
在7年期间，102例SI-NENs患者中有50例仅接受了小肠切除术；其中，25例行VS-LA，25例行Con-LA。与Con-LA患者相比，VS-LA患者的疾病往往更晚期，腹痛、肠系膜萎缩发生率略高，Ⅲ级淋巴结受累更多。然而，VS-LA导致切除的肠段更短（中位数40 cm对65 cm，P = 0.007），局部R0切除率（72%对84%）和切除的淋巴结数量（中位数13对13）相似。VS-LA组25例中有1例（4%）发生术后临床相关并发症，Con-LA组25例中有7例（28%）发生（P = 0.02）。术后3个月，VS-LA组25例中有1例（4%）患者和Con-LA组25例中有10例（40%）患者抱怨腹痛（P = 0.002）。VS-LA组8例完全切除Ⅲ期疾病的患者中有1例，Con-LA组13例中有2例抱怨腹泻（P = 0.31）。
VS-LA在肿瘤学上似乎是安全的，在SI-NENs的小肠切除术中应予以考虑。
