Chaudhari Vikram A, Kunte Aditya R, Chopde Amit N, Ostwal Vikas, Ramaswamy Anant, Engineer Reena, Bhargava Prabhat, Bal Munita, Shetty Nitin, Kulkarni Suyash, Patkar Shraddha, Bhandare Manish S, Shrikhande Shailesh V
GI & HPB Surgical Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
BJS Open. 2024 Jul 2;8(4). doi: 10.1093/bjsopen/zrae065.
The evolution and outcomes of extended pancreatectomies at a single institute over 15 years are presented in this study.
A retrospective analysis of the institutional database was performed from 2015 to 2022 (period B). Patients undergoing extended pancreatic resections, as defined by the International Study Group for Pancreatic Surgery, were included. Perioperative and survival outcomes were compared with data from 2007-2015 (period A). Regression analyses were used to identify factors affecting postoperative and long-term survival outcomes.
A total of 197 (16.1%) patients underwent an extended resection in period B compared to 63 (9.2%) in period A. Higher proportions of borderline resectable (5 (18.5%) versus 51 (47.7%), P = 0.011) and locally advanced tumours (1 (3.7%) versus 24 (22.4%), P < 0.001) were resected in period B with more frequent use of neoadjuvant therapy (6 (22.2%) versus 79 (73.8%), P < 0.001). Perioperative mortality (4 (6.0%) versus 12 (6.1%), P = 0.81) and morbidity (23 (36.5%) versus 83 (42.1%), P = 0.57) rates were comparable. The overall survival for patients with pancreatic adenocarcinoma was similar in both periods (17.5 (95% c.i. 6.77 to 28.22) versus 18.3 (95% c.i. 7.91 to 28.68) months, P = 0.958). Resectable, node-positive tumours had a longer disease-free survival (DFS) in period B (5.81 (95% c.i. 1.73 to 9.89) versus 14.03 (95% c.i. 5.7 to 22.35) months, P = 0.018).
Increasingly complex pancreatic resections were performed with consistent perioperative outcomes and improved DFS compared to the earlier period. A graduated approach to escalating surgical complexity, multimodality treatment, and judicious patient selection enables the resection of advanced pancreatic tumours.
本研究展示了一家机构在15年间扩大胰腺切除术的演变及结果。
对2015年至2022年（时期B）的机构数据库进行回顾性分析。纳入国际胰腺手术研究组定义的接受扩大胰腺切除术的患者。将围手术期和生存结果与2007 - 2015年（时期A）的数据进行比较。采用回归分析确定影响术后和长期生存结果的因素。
时期B共有197例（16.1%）患者接受了扩大切除术，而时期A为63例（9.2%）。时期B切除的临界可切除肿瘤（5例（18.5%）对51例（47.7%），P = 0.011）和局部晚期肿瘤（1例（3.7%）对24例（22.4%），P < 0.001）比例更高，新辅助治疗的使用更频繁（6例（22.2%）对79例（73.8%），P < 0.001）。围手术期死亡率（4例（6.0%）对12例（6.1%），P = 0.81）和发病率（23例（36.5%）对83例（42.1%），P = 0.57）相当。两个时期胰腺腺癌患者的总生存期相似（17.5（95%置信区间6.77至28.22）个月对18.3（95%置信区间7.91至28.68）个月，P = 0.958）。可切除的淋巴结阳性肿瘤在时期B的无病生存期更长（5.81（95%置信区间1.73至9.89）个月对14.03（95%置信区间5.7至22.35）个月，P = 0.018）。
与早期相比，实施了越来越复杂的胰腺切除术，围手术期结果一致，无病生存期得到改善。逐步增加手术复杂性、多模式治疗和明智的患者选择能够实现晚期胰腺肿瘤的切除。
