胰腺癌胰十二指肠切除术中切线与节段性门静脉肠系膜静脉切除：一项关于手术及肿瘤学结局的国际多中心队列研究

Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer: An International Multicenter Cohort Study on Surgical and Oncological Outcome.

作者信息

Stoop Thomas F, Molnár Adrienne, Seelen Leonard W F, Sugawara Toshitaka, Scheepens Jacobien C M, Ali Mahsoem, Javed Ammar A, Halimi Asif, Oba Atsushi, Groot Koerkamp Bas, Andersson Bodil, Williamsson Caroline, Wolfgang Christopher L, Ban Daisuke, Sparrelid Ernesto, Daams Freek, Kazemier Geert, van Santvoort Hjalmar C, Rompen Ingmar F, Molenaar I Quintus, Habib Joseph R, Beuk Lysanne P M, Geerdink Niek J, de Wilde Roeland F, Busch Olivier R, Swartling Oskar, Bereza-Carlson Paulina, Ghorbani Poya, Kruize Reeve L, Schulick Richard D, Franco Salvador Rodriguez, Miyata Tatsunori, Franklin Oskar, Inoue Yosuke, Besselink Marc G, Del Chiaro Marco

机构信息

Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.

Cancer Center Amsterdam, Amsterdam, the Netherlands.

出版信息

Ann Surg. 2025 Jan 22. doi: 10.1097/SLA.0000000000006638.

DOI:10.1097/SLA.0000000000006638

PMID:39846439

Abstract

OBJECTIVE

To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement.

SUMMARY BACKGROUND DATA

Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability.

METHODS

International retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders.

RESULTS

Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95%CI, 17-32) after tangential and 23% (95%CI, 17-30) after segmental PVR (P=0.98). After adjusting for confounders, PVR type was not associated with OS (HR=0.94 [95%CI, 0.69-1.30]), RFS (HR=0.94 [95% CI, 0.69 to 1.28), and locoregional recurrence (OR=0.76 [95%CI, 0.40-1.46]).

CONCLUSIONS

In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180° PMV involvement, the type of PVR (i.e., tangential vs. segmental) was not associated with differences in surgical and oncological outcome. This suggest that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.

摘要

目的

探讨对于因胰腺癌累及门静脉肠系膜静脉（PMV）而接受胰十二指肠切除术的患者，切线式与节段式门静脉肠系膜静脉切除（PVR）对手术及肿瘤学结局的影响。

总结背景数据

目前关于切线式与节段式PVR作为胰腺癌胰十二指肠切除术一部分的比较研究纳入了所有程度的PMV累及情况，包括切线式PVR可能不可行的病例，这限制了临床适用性。

方法

一项来自5个国家10个中心的国际回顾性研究，纳入了2014 - 2020年期间所有因胰腺癌接受胰十二指肠切除术并行PVR且诊断时横断面成像显示PMV累及≤180°的连续患者。进行Cox和逻辑回归分析，以研究切线式与节段式PVR与手术总生存期（OS）、无复发生存期（RFS）、局部区域复发以及住院/30天严重并发症之间的关联，并对潜在混杂因素进行校正。

结果

总体而言，纳入了357例行胰十二指肠切除术并行PVR的患者（42%为切线式PVR，58%为节段式PVR）。切线式PVR后住院/30天严重并发症的校正风险为23%（95%CI，17 - 32），节段式PVR后为23%（95%CI，17 - 30）（P = 0.98）。在校正混杂因素后，PVR类型与OS（风险比[HR]=0.94 [95%CI，0.69 - 1.30]）、RFS（HR = 0.94 [95%CI，0.69至1.28]）和局部区域复发（优势比[OR]=0.76 [95%CI，0.40 - 1.46]）均无关联。