术中不可逆电穿孔切缘强化对胰腺癌切除术后局部复发的影响。
Impact of margin accentuation with intraoperative irreversible electroporation on local recurrence in resected pancreatic cancer.
机构信息
Division of Surgical Oncology, The Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville School of Medicine, KY.
Division of Surgical Oncology, The Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville School of Medicine, KY.
出版信息
Surgery. 2023 Mar;173(3):581-589. doi: 10.1016/j.surg.2022.07.033. Epub 2022 Oct 8.
BACKGROUND
The purpose of this study was to evaluate the rates of local recurrence and margin positivity in patients with borderline resectable pancreatic cancer after pancreatectomy with or without irreversible electroporation with margin accentuation.
METHODS
Prospective data for preoperative stages IIB (borderline resectable) and III were evaluated, with 75 patients undergoing pancreatectomy with irreversible electroporation with margin accentuation compared to 71 patients who underwent pancreatectomy alone from March 2010 to November 2020.
RESULTS
Both irreversible electroporation with margin accentuation and pancreatectomy-alone groups were similar for body mass index, Charleston comorbidity index, and sex. The irreversible electroporation with margin accentuation group had significantly greater preoperative stage III (irreversible electroporation 83% vs pancreatectomy alone 51%; P = .0001), with similar tumor location (head 64% vs 72%) and tumor size (median 2.9 vs 2.8). Neoadjuvant/induction chemotherapy and prior radiation therapy was similar in both groups (irreversible electroporation with margin accentuation 89% vs 72%). Surgical therapy included a greater percentage of pancreaticoduodenectomy in the pancreatectomy-alone group. Despite greater stage and greater percentage of margin positivity (irreversible electroporation with margin accentuation 27% vs 20%; P = not significant), rates of local recurrence were similar. The mean disease-free interval for local recurrence from time of diagnosis was similar (irreversible electroporation with margin accentuation 15.8 vs 16.5 pancreatectomy alone; P = not significant) and time of treatment (irreversible electroporation with margin accentuation 9.4 vs 10.5 months; P = not significant). Overall survival was improved with the irreversible electroporation with margin accentuation group, with a mean of 34.2 months versus 27.9 months in the pancreatectomy-alone group.
CONCLUSION
Irreversible electroporation with margin accentuation is safe and effective in stages IIB and III pancreatic adenocarcinomas that are technically resectable. Despite higher margin positivity rates, the time to local recurrence and the effects of recurrence were the same in the pancreatectomy-alone group.
背景
本研究旨在评估行胰腺切除术联合或不联合不可逆电穿孔术（IRE）切缘增强术治疗边界可切除胰腺癌患者的局部复发率和切缘阳性率。
方法
对 2010 年 3 月至 2020 年 11 月期间术前分期为 IIB 期（边界可切除）和 III 期的患者前瞻性数据进行评估，75 例患者行胰腺切除术联合 IRE 切缘增强术，71 例患者行单纯胰腺切除术。
结果
IRE 切缘增强术组和单纯胰腺切除术组在体质指数、Charlson 合并症指数和性别方面相似。IRE 切缘增强术组 III 期患者比例明显更高（IRE 组 83%，单纯胰腺切除术组 51%；P=0.0001），肿瘤位置（头部 64%比 72%）和肿瘤大小（中位数 2.9cm 比 2.8cm）相似。两组新辅助/诱导化疗和放疗前相似（IRE 切缘增强术组 89%，单纯胰腺切除术组 72%）。手术治疗包括更多的单纯胰腺切除术组行胰十二指肠切除术。尽管 IRE 切缘增强术组的切缘阳性率更高（27%比 20%；P=非显著），但局部复发率相似。从诊断时开始的局部复发无病间隔时间相似（IRE 切缘增强术组 15.8 个月比单纯胰腺切除术组 16.5 个月；P=非显著），治疗时间相似（IRE 切缘增强术组 9.4 个月比单纯胰腺切除术组 10.5 个月；P=非显著）。IRE 切缘增强术组的总生存率得到改善，平均为 34.2 个月，而单纯胰腺切除术组为 27.9 个月。
结论
IRE 切缘增强术在技术上可切除的 IIB 期和 III 期胰腺腺癌中是安全有效的。尽管切缘阳性率较高，但在单纯胰腺切除术组中，局部复发的时间和复发的影响是相同的。
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