HPB and Transplant Unit, University of Montpellier, Montpellier, France.
Ospedale Policlinico San Martino, Genova, Italy.
Langenbecks Arch Surg. 2023 Sep 30;408(1):386. doi: 10.1007/s00423-023-03110-0.
Due to delayed diagnosis and a lower surgical indication rate, left-sided pancreatic ductal adenocarcinoma (PDAC) is often associated with a poor prognosis in comparison to pancreatic head tumors. Multi-visceral resections (MVR) associated with distal pancreatectomy could be proposed for patients presenting with locally infiltrating disease.
We retrospectively analyzed a multi-centric cohort of left-sided PDAC patients operated on from 2009 to 2020. Thirteen European high-volume HPB centers participated in this study. We analyzed patients who underwent distal pancreatectomy (DP) associated with MVR and compared them to standard DP patients.
Among 258 patients treated curatively for PDAC of the body and tail, 28 patients successfully underwent MVR. A longer operative time was observed in the MVR group (295 min +/- 74 vs. 250 min +/- 96, p= 0.248). The post-operative complication rate was comparable between the two groups (46.4% in the MVR group vs. 62.2% in the control group, p= 0.108). The incidence of positive margin (R1) was similar between the two groups (28.6% vs. 26.6%; p=0.827). After a median follow-up of 25 (9-111) months, overall survival was comparable between the two groups (p= 0.519).
Multi-visceral resection in left-sided pancreatic ductal adenocarcinoma is safe and feasible and should be considered in selected cases as it seems to provide acceptable surgical and oncological outcomes.
与胰头部肿瘤相比，由于诊断延迟和手术适应证率较低，左侧胰腺导管腺癌（PDAC）常与预后不良相关。对于局部浸润性疾病的患者，可以提出与胰体尾切除术相关的多脏器切除术（MVR）。
我们回顾性分析了 2009 年至 2020 年期间接受手术治疗的左侧 PDAC 患者的多中心队列。13 个欧洲大容量 HPB 中心参与了这项研究。我们分析了接受胰体尾切除术（DP）联合 MVR 的患者，并将其与标准 DP 患者进行比较。
在 258 例接受 PDAC 体尾根治性治疗的患者中，有 28 例成功进行了 MVR。MVR 组的手术时间较长（295 分钟±74 分钟与 250 分钟±96 分钟，p=0.248）。两组术后并发症发生率相当（MVR 组 46.4%，对照组 62.2%，p=0.108）。两组阳性切缘（R1）的发生率相似（MVR 组 28.6%，对照组 26.6%；p=0.827）。在中位数为 25（9-111）个月的随访后，两组的总生存率相当（p=0.519）。
左侧胰腺导管腺癌的多脏器切除术是安全可行的，在某些情况下应考虑使用，因为它似乎提供了可接受的手术和肿瘤学结果。
