保留脾脏的远端胰腺切除术在高分化无功能性胰腺神经内分泌肿瘤中的价值：一项比较研究。

Values of spleen-preserving distal pancreatectomy in well-differentiated non-functioning pancreatic neuroendocrine tumors: a comparative study.

作者信息

Huang Xi-Tai, Xie Jin-Zhao, Cai Jian-Peng, Fang Peng, Huang Chen-Song, Chen Wei, Liang Li-Jian, Yin Xiao-Yu

机构信息

Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.

出版信息

Gastroenterol Rep (Oxf). 2022 Oct 13;10:goac056. doi: 10.1093/gastro/goac056. eCollection 2022.

DOI:10.1093/gastro/goac056

PMID:36263393

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9562143/

Abstract

BACKGROUND

The feasibility of spleen-preserving distal pancreatectomy (SPDP) to treat well-differentiated non-functioning pancreatic neuroendocrine tumors (NF-pNETs) located at the body and/or tail of the pancreas remains controversial. Distal pancreatectomy with splenectomy (DPS) has been widely applied in the treatment of NF-pNETs; however, it may increase the post-operative morbidities. This study aimed to evaluate whether SPDP is inferior to DPS in post-operative outcomes and survivals when being used to treat patients with NF-pNETs in our institute.

METHODS

Clinicopathological features of patients with NF-pNETs who underwent curative SPDP or DPS at the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between January 2010 and January 2022 were collected. Short-term outcomes and 5-year survivals were compared between patients undergoing SPDP and those undergoing DPS.

RESULTS

Sixty-three patients (SPDP, 27; DPS, 36) with well-differentiated NF-pNETs were enrolled. All patients had grade 1/2 tumors. After identifying patients with T1-T2 NF-pNETs (SPDP, 27; DPS, 15), there was no disparity between the SPDP and DPS groups except for tumor size (median, 1.4 vs 2.6 cm, =0.001). There were no differences in operation time (median, 250 vs 295 min, =0.478), intraoperative blood loss (median, 50 vs 100 mL, =0.145), post-operative major complications (3.7% vs 13.3%, =0.287), clinically relevant post-operative pancreatic fistula (22.2% vs 6.7%, =0.390), or post-operative hospital stays (median, 9 vs 9 days, =0.750) between the SPDP and DPS groups. Kaplan-Meier curve showed no significant differences in the 5-year overall survival rate (100% vs 100%, log-rank >0.999) or recurrence-free survival (100% vs 100%, log-rank >0.999) between patients with T1-T2 NF-pNETs undergoing SPDP and those undergoing DPS.

CONCLUSIONS

In patients with T1-T2 well-differentiated NF-pNETs, SPDP could achieve comparable post-operative outcomes and prognosis compared with DPS.

摘要

背景

保留脾脏的胰腺远端切除术（SPDP）治疗位于胰腺体部和/或尾部的高分化无功能性胰腺神经内分泌肿瘤（NF-pNETs）的可行性仍存在争议。胰体尾切除术联合脾切除术（DPS）已广泛应用于NF-pNETs的治疗；然而，它可能会增加术后发病率。本研究旨在评估在我院使用SPDP治疗NF-pNETs患者时，其术后结局和生存率是否劣于DPS。

方法

收集2010年1月至2022年1月在中山大学附属第一医院（中国广州）接受根治性SPDP或DPS的NF-pNETs患者的临床病理特征。比较接受SPDP和DPS的患者的短期结局和5年生存率。

结果

纳入63例高分化NF-pNETs患者（SPDP组27例，DPS组36例）。所有患者的肿瘤分级均为1/2级。在确定T1-T2期NF-pNETs患者后（SPDP组27例，DPS组15例），除肿瘤大小外（中位数分别为1.4 cm和2.6 cm，P = 0.001），SPDP组和DPS组之间没有差异。SPDP组和DPS组在手术时间（中位数分别为250分钟和295分钟，P = 0.478）、术中出血量（中位数分别为50 mL和100 mL，P =

0.145）、术后主要并发症（3.7% vs 13.3%，P = 0.287）、临床相关的术后胰瘘（22.2% vs 6.7%，P = 0.390）或术后住院时间（中位数均为9天，P = 0.750）方面均无差异。Kaplan-Meier曲线显示，接受SPDP和DPS的T1-T2期NF-pNETs患者的5年总生存率（100% vs 100%，对数秩检验P>0.999）或无复发生存率（100% vs 100%，对数秩检验P>0.999）无显著差异。