Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK.
Colorectal Dis. 2023 Jan;25(1):16-23. doi: 10.1111/codi.16303. Epub 2022 Sep 1.
Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD-RC) to achieve curative, margin-negative resection, but the safety and benefit of this uncommon procedure has not been established. The Association of Coloproctology of Great Britain and Ireland IMPACT initiative has also highlighted a lack of awareness about current services available within the UK for patients with advanced colorectal cancer and concerns about low-volume centres managing complex cases. Thus, we aimed to review the feasibility, safety and long-term outcomes of this procedure at a single high-volume hepatopancreaticobiliary surgery unit in the UK.
A retrospective cohort study was performed using a database of all consecutive patients with intestinal cancer who had been referred to our regional advanced multidisciplinary team and undergone PD-RC in a 7-year period (2013-2020). Clinico-pathological and outcome data were reviewed.
Ten patients (mean age 54 ± 13, 8/10 men) were identified. Final histology revealed the primary tumour sites were colon (n = 7) and duodenum (n = 3). R0 resection was achieved in all cases. The major complication rate (Clavien-Dindo ≥ 3) was 10% (1/10) with no deaths within 90 days of surgery. The Kaplan-Meier estimated 5-year overall survival was 83.3% (95% CI 58.3%-100%). Univariate survival analysis identified perineural invasion and extra-colonic origin as predictors of poor survival (log-rank P < 0.05).
En bloc PD-RC for locally advanced intestinal cancer can be performed safely with a high proportion of margin-negative resections and resultant long-term survival in carefully selected patients.
包括结肠癌在内的局部晚期肠肿瘤可能需要根治性整块胰十二指肠切除术和右半结肠切除术（PD-RC），以实现治愈性、切缘阴性的切除，但该不常见手术的安全性和益处尚未得到证实。英国肛肠病学会的 IMPACT 计划也强调了人们对英国为晚期结直肠癌患者提供的现有服务缺乏认识，以及对低容量中心处理复杂病例的担忧。因此，我们旨在回顾在英国的一个高容量肝胆胰外科单位中，该手术的可行性、安全性和长期结果。
对所有连续的肠肿瘤患者进行了回顾性队列研究，这些患者均被转诊到我们的区域先进多学科团队，并在 7 年内（2013-2020 年）接受了 PD-RC。回顾了临床病理和结果数据。
确定了 10 名患者（平均年龄 54±13 岁，8/10 名男性）。最终组织学显示原发肿瘤部位为结肠（n=7）和十二指肠（n=3）。所有病例均达到了 R0 切除。主要并发症发生率（Clavien-Dindo≥3）为 10%（1/10），术后 90 天内无死亡。Kaplan-Meier 估计的 5 年总生存率为 83.3%（95%CI 58.3%-100%）。单变量生存分析表明，神经周围侵犯和结外起源是生存不良的预测因素（对数秩 P<0.05）。
对于精心选择的患者，整块胰十二指肠切除术和右半结肠切除术治疗局部晚期肠肿瘤可以安全进行，并且具有较高的切缘阴性切除率和长期生存率。
