胰腺癌行远端胰腺切除术联合腹腔干切除术（DP-CAR）的15年经验——一项韩国全国性调查
15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer-A Korean Nationwide Investigation.
作者信息
Yoon So Jeong, Park Sang-Jae, Yoon Yoo-Seok, Hong Tae-Ho, Jang Jin-Young, Kim Hee Joon, Heo Jin Seok, Hwang Dae Wook, Han In Woong
机构信息
Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Center for Liver Cancer, National Cancer Center, Ilsan 10408, Republic of Korea.
出版信息
Cancers (Basel). 2023 Jul 28;15(15):3850. doi: 10.3390/cancers15153850.
BACKGROUND
As systemic treatment for pancreatic cancer advances, distal pancreatectomy with celiac axis resection (DP-CAR) has been considered a curative-intent surgical option for advanced pancreatic cancer. This study aimed to review the surgical and oncologic outcomes of patients undergoing DP-CAR based on Korean nationwide data.
METHODS
We collected the data of patients who underwent DP-CAR for pancreatic cancer between 2007 and 2021 at seven major hospitals in Korea. The clinicopathological characteristics, postoperative complications, and data on the survival of the patients were retrospectively reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications and survival.
RESULTS
A total of 75 patients, consisting mainly of borderline resectable ( = 32) or locally advanced ( = 30) pancreatic cancer, were included in the analysis. Forty-two (56.0%) patients underwent neoadjuvant treatment (NAT). Twenty (26.7%) patients experienced Clavien-Dindo grade ≥ 3 complications, including four patients with ischemic gastropathy, two with hepatic ischemia, and two procedure-related mortalities. Neoadjuvant chemotherapy increased the risk of postoperative complications ( = 0.028). The median recurrence-free and overall survival were 7 and 19 months, with a 5-year survival rate of 13% and 24%, respectively. In the NAT group, a decrease in CA 19-9 and the post-NAT maximum standardized uptake value (SUVmax) in positron emission tomography were associated with survival after surgical resection.
CONCLUSIONS
Despite the possibility of major complications, DP-CAR could be a feasible option for achieving curative resection with fair survival outcomes in patients with borderline resectable or locally advanced pancreatic cancer. Further studies investigating the safety of the procedure and identifying proper surgical candidates with potential survival gains are necessary.
背景
随着胰腺癌全身治疗的进展，联合腹腔干切除术的胰体尾切除术（DP-CAR）已被视为晚期胰腺癌具有治愈意图的手术选择。本研究旨在基于韩国全国性数据回顾接受DP-CAR治疗患者的手术及肿瘤学结局。
方法
我们收集了2007年至2021年期间在韩国七家主要医院接受DP-CAR治疗胰腺癌患者的数据。对患者的临床病理特征、术后并发症及生存数据进行回顾性分析。进行逻辑回归分析以确定术后并发症和生存的危险因素。
结果
分析共纳入75例患者，主要为临界可切除（n = 32）或局部进展期（n = 30）胰腺癌患者。42例（56.0%）患者接受了新辅助治疗（NAT）。20例（26.7%）患者发生Clavien-Dindo≥3级并发症，包括4例缺血性胃病患者、2例肝缺血患者和2例与手术相关的死亡病例。新辅助化疗增加了术后并发症的风险（P = 0.028）。无复发生存期和总生存期的中位数分别为7个月和19个月，5年生存率分别为13%和24%。在NAT组中，CA 19-9的降低以及正电子发射断层扫描中NAT后最大标准化摄取值（SUVmax）与手术切除后的生存相关。
结论
尽管存在发生严重并发症的可能性，但对于临界可切除或局部进展期胰腺癌患者，DP-CAR可能是实现根治性切除并获得较好生存结局的可行选择。有必要进一步研究该手术的安全性并确定可能获得生存获益的合适手术候选者。
Zotero 插件