Burasakarn Pipit, Thienhiran Anuparp, Fuengfoo Pusit, Hongjinda Sermsak
Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand.
Innov Surg Sci. 2022 Jun 28;7(1):5-11. doi: 10.1515/iss-2021-0034. eCollection 2022 Mar 1.
To investigate the risk factors for early recurrence after curative pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma.
All data were retrospectively collected from patients with resectable pancreatic ductal adenocarcinoma who had undergone pancreatoduodenectomy at the Department of Surgery, Phramongkutklao Hospital, from January 2015 to December 2020. The preoperative and perioperative risk factors were included into the analysis.
In total, 34 patients were included in the study. The median time for recurrence and median survival time were 17 and 20 months, respectively. The 1, 3, and 5 year disease-free survival rates were 59.6%, 23.87%, and 23.87%, respectively, while the 1, 3, and 5 year overall survival rates were 81%, 24.7%, and 12.4%, respectively. Seventeen patients (50%) from a total of 34 patients had recurrence, and ten patients (29.41%) had recurrence within 12 months. The independent preoperative risk factor associated with adverse disease-free survival was tumor size > 4 cm (hazard ratio [HR], 14.34, p=0.022). The perioperative risk factors associated with adverse disease-free survival were pathological lymphovascular invasion (HR, 4.31; p=0.048) and non-hepatopancreatobiliary surgeon (HR, 5.9; p=0.022). Risk factors associated with poor overall survival were microscopical margin positive (R1) resection (HR, 3.68; p=0.019) and non-hepatopancreatobiliary surgeon (HR, 3.45; p=0.031).
Tumor size > 4 cm from the preoperative imaging study was a poor prognostic factor for early recurrence after curative pancreatoduodenectomy for resectable pancreatic adenocarcinoma indicated that they may have radiological occult metastasis, thus, staging laparoscopy may reduce the number of unnecessary laparotomies and avoid missing radiologically negative metastases.
探讨可切除性胰腺导管腺癌根治性胰十二指肠切除术后早期复发的危险因素。
回顾性收集2015年1月至2020年12月在佛统府医院外科接受胰十二指肠切除术的可切除性胰腺导管腺癌患者的所有数据。将术前和围手术期危险因素纳入分析。
本研究共纳入34例患者。复发的中位时间和中位生存时间分别为17个月和20个月。1年、3年和5年无病生存率分别为59.6%、23.87%和23.87%，而1年、3年和5年总生存率分别为81%、24.7%和12.4%。34例患者中有17例（50%）复发，10例（29.41%）在12个月内复发。与无病生存不良相关的独立术前危险因素是肿瘤大小>4 cm（风险比[HR]，14.34，p = 0.022）。与无病生存不良相关的围手术期危险因素是病理淋巴管侵犯（HR，4.31；p = 0.048）和非肝胰胆外科医生（HR，5.9；p = 0.022）。与总生存不良相关的危险因素是显微镜下切缘阳性（R1）切除（HR，3.68；p = 0.019）和非肝胰胆外科医生（HR，3.45；p = 0.031）。
术前影像学检查显示肿瘤大小>4 cm是可切除性胰腺腺癌根治性胰十二指肠切除术后早期复发的不良预后因素，提示可能存在影像学隐匿性转移，因此，分期腹腔镜检查可能会减少不必要的剖腹手术数量，并避免遗漏影像学阴性转移灶。
