Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Br J Surg. 2023 Sep 6;110(10):1387-1394. doi: 10.1093/bjs/znad212.
Distal pancreatectomy with en bloc coeliac axis resection (DP-CAR) for pancreatic body cancer has been reported increasingly. However, its large-scale outcomes remain undocumented. This study aimed to evaluate DP-CAR volume and mortality, preoperative arterial embolization for ischaemic gastropathy, the oncological benefit for resectable tumours close to the bifurcation of the splenic artery and coeliac artery using propensity score matching, and prognostic factors in DP-CAR.
In a multi-institutional analysis, 626 DP-CARs were analysed retrospectively and compared with 1325 distal pancreatectomies undertaken in the same interval.
Ninety-day mortality was observed in 7 of 21 high-volume centres (1 or more DP-CARs per year) and 1 of 41 low-volume centres (OR 20.00, 95 per cent c.i. 2.26 to 177.26). The incidence of ischaemic gastropathy was 19.2 per cent in the embolization group and 7.9 per cent in the no-embolization group (OR 2.77, 1.48 to 5.19). Propensity score matching analysis showed that median overall survival was 33.5 (95 per cent c.i. 27.4 to 42.0) months in the DP-CAR and 37.9 (32.8 to 53.3) months in the DP group. Multivariable analysis identified age at least 67 years (HR 1.40, 95 per cent c.i. 1.12 to 1.75), preoperative tumour size 30 mm or more (HR 1.42, 1.12 to 1.80), and preoperative carbohydrate antigen 19-9 level over 37 units/ml (HR 1.43, 1.11 to 1.83) as adverse prognostic factors.
DP-CAR can be performed safely in centres for general pancreatic surgery regardless of DP-CAR volume, and preoperative embolization may not be required. This procedure has no oncological advantage for resectable tumour close to the bifurcation of the splenic artery, and should be performed after appropriate patient selection.
胰体癌的胰体尾切除术联合整块腹腔动脉切除术（DP-CAR）已被越来越多地报道。然而，其大规模的结果仍未被记录。本研究旨在通过倾向评分匹配评估 DP-CAR 的手术量和死亡率、用于预防缺血性胃病的术前动脉栓塞、对靠近脾动脉和腹腔动脉分叉的可切除肿瘤的肿瘤学益处，以及 DP-CAR 的预后因素。
在多机构分析中，回顾性分析了 626 例 DP-CAR，并与同期进行的 1325 例胰体尾切除术进行了比较。
在 21 个高容量中心（每年 1 例或以上 DP-CAR）中有 7 例（7/21，33.3%）和 41 个低容量中心（每年少于 1 例 DP-CAR）中有 1 例（1/41，2.4%）在 90 天内死亡（OR 20.00，95%CI 2.26 至 177.26）。在栓塞组中，缺血性胃病的发生率为 19.2%，在非栓塞组中为 7.9%（OR 2.77，1.48 至 5.19）。倾向评分匹配分析显示，DP-CAR 组的中位总生存期为 33.5 个月（95%CI 27.4 至 42.0），DP 组为 37.9 个月（95%CI 32.8 至 53.3）。多变量分析确定年龄至少 67 岁（HR 1.40，95%CI 1.12 至 1.75）、术前肿瘤大小 30 毫米或以上（HR 1.42，1.12 至 1.80）和术前癌抗原 19-9 水平超过 37 单位/ml（HR 1.43，1.11 至 1.83）是不良预后因素。
DP-CAR 可以在普通胰腺外科中心安全进行，而与 DP-CAR 的手术量无关，并且术前栓塞可能不是必需的。对于靠近脾动脉分叉的可切除肿瘤，该手术没有肿瘤学优势，应在适当的患者选择后进行。
