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2021/2022年重要更新:胰腺导管腺癌寡转移的手术结果

Essential updates 2021/2022: Surgical outcomes of oligometastasis in pancreatic ductal adenocarcinoma.

作者信息

Yasuda Satoshi, Nagai Minako, Terai Taichi, Kohara Yuichiro, Sho Masayuki

机构信息

Department of Surgery Nara Medical University Nara Japan.

出版信息

Ann Gastroenterol Surg. 2023 Jan 18;7(3):358-366. doi: 10.1002/ags3.12655. eCollection 2023 May.

Abstract

Oligometastatic disease has been proposed as an intermediate state between localized and polymetastatic disease that can benefit from multimodal treatment, including surgery. There is a growing concern about performing surgery for oligometastatic pancreatic ductal adenocarcinoma, although there is still little evidence. We reviewed articles published between 2021 and 2022, focusing mainly on surgical outcomes. Furthermore, we summarized the current status of surgery in the multidisciplinary treatment of oligometastatic pancreatic cancer and discuss future perspectives. In liver oligometastasis, multimodal treatment including surgery achieved favorable long-term survival, especially in patients with good responses to preoperative chemotherapy, with a median survival time from 25.5 to 54.6 months. In addition, the data from the National Cancer Database in the United States showed that patients who underwent surgery for oligometastatic liver metastases had a significantly longer overall survival than those who received chemotherapy alone. Prognostic biomarkers were identified, including carbohydrate antigen 19-9 (CA19-9) levels at diagnosis and preoperative chemotherapy with normalization of CA19-9 levels or favorable radiological response. Patients with lung oligometastasis had a more favorable long-term prognosis than those with other recurrence sites, and the updated literature further confirmed the previous studies. Overall survival was favorable, with 84 months after initial surgery and 29.2 months after metastasectomy, and a 5-year survival rate of 60.6% was also reported. In peritoneal oligometastasis, the results of conversion surgery after good responses to preoperative treatment with intraperitoneal therapy or systematic chemotherapy were reported, and the conversion rate and long-term prognosis were favorable. There is a growing concern about performing surgery for oligometastatic pancreatic ductal adenocarcinoma. We reviewed articles published between 2021 and 2022, focusing mainly on surgical outcomes. Furthermore, we summarize the current status of surgery in multidisciplinary treatment of oligometastatic pancreatic cancer and discuss future perspectives.

摘要

寡转移疾病被认为是局部疾病和多转移疾病之间的一种中间状态,可从包括手术在内的多模式治疗中获益。尽管证据仍然很少,但对于寡转移胰腺导管腺癌进行手术的担忧日益增加。我们回顾了2021年至2022年发表的文章,主要关注手术结果。此外,我们总结了寡转移胰腺癌多学科治疗中手术的现状,并讨论了未来的前景。在肝寡转移中,包括手术在内的多模式治疗取得了良好的长期生存效果,特别是对术前化疗反应良好的患者,中位生存时间为25.5至54.6个月。此外,美国国家癌症数据库的数据显示,接受寡转移肝转移手术的患者总生存期明显长于单纯接受化疗的患者。已确定了预后生物标志物,包括诊断时的糖类抗原19-9(CA19-9)水平以及术前化疗后CA19-9水平正常化或影像学反应良好。肺寡转移患者的长期预后比其他复发部位的患者更有利,最新文献进一步证实了先前的研究。总体生存情况良好,初次手术后84个月,转移灶切除术后29.2个月,也有报道5年生存率为60.6%。在腹膜寡转移中,报告了术前接受腹腔内治疗或全身化疗后反应良好的转化手术结果,转化率和长期预后良好。对于寡转移胰腺导管腺癌进行手术的担忧日益增加。我们回顾了2021年至2022年发表的文章,主要关注手术结果。此外,我们总结了寡转移胰腺癌多学科治疗中手术的现状,并讨论了未来的前景。

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本文引用的文献

1
Oncological Outcome of Conversion Surgery After Preoperative Chemotherapy for Metastatic Pancreatic Cancer.
Ann Surg. 2023 May 1;277(5):e1089-e1098. doi: 10.1097/SLA.0000000000005481. Epub 2022 Jun 27.
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Outcomes of pancreatic cancer with liver oligometastasis.
J Hepatobiliary Pancreat Sci. 2023 Feb;30(2):229-239. doi: 10.1002/jhbp.1184. Epub 2022 Jun 1.
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Surgical treatment of hepatic oligometastatic pancreatic ductal adenocarcinoma: An analysis of the National Cancer Database.
Surgery. 2022 Jun;171(6):1464-1470. doi: 10.1016/j.surg.2021.12.029. Epub 2022 Feb 1.

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