Huang X M, Zhang K, Yin J, Wu P F, Cai B B, Lu Z P, Tu M, Chen J M, Guo F, Xi C H, Wei J S, Wu J L, Gao W T, Dai C C, Miao Y, Jiang K R
Pancreas Center,First Affiliated Hospital of Nanjing Medical University,Pancreas Institute,Nanjing Medical University,Nanjing 210029,China.
Zhonghua Wai Ke Za Zhi. 2023 Oct 1;61(10):894-900. doi: 10.3760/cma.j.cn112139-20230327-00123.
To investigate the clinical efficacy of distal pancreatectomy with celiac axis resection(DP-CAR). A total of 89 consecutive patients (50 males and 39 females) who were diagnosed with pancreatic body cancer and underwent DP-CAR in Pancreas Center,First Affiliated Hospital of Nanjing Medical University between September 2013 and June 2022 were retrospectively reviewed. There were 50 males and 39 females,with age((IQR)) of 63(12) years(range:43 to 81 years). Perioperative parameters,pathology results and follow-up data of these patients were analyzed, or Fisher's test for categorical data while the Wilcoxon test for quantitative data. Survival results were estimated by the Kaplan-Meier survival method. Among 89 cases,cases combined with portal vein-superior mesenteric vein or organ resection accounted for 22.5% (20/89) and 42.7% (38/89),respectively. The operative time,blood loss and postoperative hospital stay were 270 (110) minutes,300 (300) ml and 13 (10) days,respectively. The overall morbidity rate was 67.4% (60/89) while the major morbidity was 11.2% (10/89). The increase rate in transient liver enzymes was 42.7% (38/89),3.4% (3/89) for liver failure,53.9% (48/89) for clinically relevant postoperative pancreatic fistula,1.1% (1/89) for bile leak,3.4% (3/89) for chylous leak of grade B and C,11.2% (10/89) for abdominal infection,9.0% (8/89) for postoperative hemorrhage of grade B and C,4.5% (4/89) for delayed gastric emptying,6.7% (6/89) for deep vein thrombosis,3.4% (3/89) for reoperation,4.5% (4/89)for hospital mortality,7.9% (7/89) for 90-day mortality. The pathological type was pancreatic cancer for all 89 cases and pancreatic ductal adenocarcinoma made up 92.1% (82/89). The tumor size was 4.8(2.0) cm, ranging from 1.5 to 12.0 cm. The number of lymph nodes harvested was 14 (13)(range:2 to 33),with a positive lymph node rate of 13.0% (24.0%). The resection R0 rate was 30.0% (24/80) and the R1 (<1 mm) rate was 58.8% (47/80). The median overall survival time was 21.3 months (95%: 15.6 to 24.3) and the median disease-free survival time was 19.1 months (95%: 11.7 to 25.1). The overall survival at 1-year and 2-year were 69.60% and 39.52%. The median survival time of 58 patients with adjuvant chemotherapy was 24.3 months (95%: 17.8 to 32.3) while that of 13 patients without any kind of adjuvant therapy was 8.4 months (95%: 7.3 to 22.3). Seven patients accepted neoadjuvant chemotherapy and there was no significant morbidity among them,with a resection rate of R0 of 5/7. DP-CAR is safe and feasible for selective cases,which could be more valuable in improving long-term survival when combined with (neo) adjuvant therapy.
探讨联合腹腔干切除的胰体尾切除术（DP-CAR）的临床疗效。回顾性分析了2013年9月至2022年6月期间在南京医科大学第一附属医院胰腺中心诊断为胰体癌并接受DP-CAR的89例连续患者（50例男性和39例女性）。患者年龄（四分位间距）为63（12）岁（范围：43至81岁），其中男性50例，女性39例。分析了这些患者的围手术期参数、病理结果和随访数据，分类数据采用Fisher检验，定量数据采用Wilcoxon检验。采用Kaplan-Meier生存法估计生存结果。89例患者中，联合门静脉-肠系膜上静脉或器官切除的病例分别占22.5%（20/89）和42.7%（38/89）。手术时间、出血量和术后住院时间分别为270（110）分钟、300（300）毫升和13（10）天。总发病率为67.4%（60/89），主要发病率为11.2%（10/89）。一过性肝酶升高率为42.7%（38/89），肝衰竭为3.4%（3/89），临床相关术后胰瘘为53.9%（48/89），胆漏为1.1%（1/89），B级和C级乳糜漏为3.4%（3/89），腹腔感染为11.2%（10/89），B级和C级术后出血为9.0%（8/89），胃排空延迟为4.5%（4/89），深静脉血栓形成率为6.7%（6/89），再次手术率为3.4%（3/89），医院死亡率为4.5%（4/89），90天死亡率为7.9%（7/89）。89例患者病理类型均为胰腺癌，其中胰腺导管腺癌占92.1%（82/89）。肿瘤大小为4.8（2.0）厘米，范围为1.5至12.0厘米。清扫淋巴结数目为14（13）个（范围：2至33个），阳性淋巴结率为13.0%（24.0%）。R0切除率为30.0%（24/80），R1（<1毫米）切除率为58.8%（47/80）。中位总生存时间为21.3个月（95%置信区间：15.6至24.3），中位无病生存时间为19.1个月（95%置信区间：11.7至25.1）。1年和2年总生存率分别为69.60%和39.52%。58例接受辅助化疗患者的中位生存时间为24.3个月（95%置信区间：17.8至32.3），而13例未接受任何辅助治疗患者的中位生存时间为8.4个月（95%置信区间：7.3至22.3）。7例患者接受新辅助化疗，其中无显著并发症，R0切除率为5/7。DP-CAR对于选择性病例是安全可行的，联合（新）辅助治疗在提高长期生存率方面可能更有价值。
