Hirose Yuki, Oba Atsushi, Inoue Yosuke, Maekawa Aya, Kobayashi Kosuke, Omiya Kojiro, Takahashi Atsushi, Ono Yoshihiro, Sato Takafumi, Ito Hiromichi, Mie Takafumi, Sasaki Takashi, Ozaka Masato, Sasahira Naoki, Wakai Toshifumi, Takahashi Yu
Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
BJS Open. 2025 Mar 4;9(2). doi: 10.1093/bjsopen/zraf026.
The aim of this study was to investigate the feasibility and effectiveness of pancreatectomy with arterial resection/divestment for pancreatic cancer with arterial involvement in the modern era of multidisciplinary treatment.
Patients who underwent pancreatectomy with arterial resection/pancreatectomy with arterial divestment for pancreatic cancer with arterial involvement from 2010 to 2021 were retrospectively analysed, and outcomes were compared between the former (2010-2015) and latter interval (2016-2021). Survivals were compared by univariable and multivariable analyses.
Among 203 patients included, 76 underwent pancreatectomy with arterial resection and 127 underwent pancreatectomy with arterial divestment. Compared with the former interval, more patients received preoperative chemotherapy (26.6% (n = 21) versus 95% (n = 118), P < 0.001), and underwent pancreatectomy with arterial resection (30.4% (n = 24) versus 41.9% (n = 52), P = 0.287) in the latter interval. The major morbidity rate and pancreatic fistula decreased in the latter interval (major morbidity rate: P = 0.040; pancreatic fistula: P = 0.006), even among patients undergoing pancreatectomy with arterial resection (major morbidity rate: P = 0.013; pancreatic fistula: P < 0.001). Patients in the latter interval had better overall survival (26.0 versus 48.2 months, P = 0.001), even among patients undergoing pancreatectomy with arterial resection (22.0 versus 45.1 months, P = 0.076).
Within the context of modern multidisciplinary treatment, radical resection including arterial resection should be justified for patients with pancreatic cancer with arterial involvement, considering the acceptable perioperative risk and prolonged survival.
本研究旨在探讨在多学科治疗的现代时代，对伴有动脉侵犯的胰腺癌进行动脉切除/剥离的胰腺切除术的可行性和有效性。
回顾性分析2010年至2021年期间因动脉侵犯而接受动脉切除的胰腺癌胰腺切除术/动脉剥离的胰腺癌胰腺切除术的患者，并比较前一时期（2010 - 2015年）和后一时期（2016 - 2021年）的结果。通过单变量和多变量分析比较生存率。
在纳入的203例患者中，76例行动脉切除的胰腺切除术，127例行动脉剥离的胰腺切除术。与前一时期相比，后一时期更多患者接受了术前化疗（26.6%（n = 21）对95%（n = 118），P < 0.001），且接受动脉切除的胰腺切除术的患者更多（30.4%（n = 24）对41.9%（n = 52），P = 0.287）。后一时期主要并发症发生率和胰瘘发生率降低（主要并发症发生率：P = 0.040；胰瘘：P = 0.006），即使在接受动脉切除的胰腺切除术的患者中也是如此（主要并发症发生率：P = 0.013；胰瘘：P < 0.001）。后一时期的患者总体生存期更好（26.0个月对48.2个月，P = 0.001），即使在接受动脉切除的胰腺切除术的患者中也是如此（22.0个月对45.1个月，P = 0.076）。
在现代多学科治疗的背景下，考虑到可接受的围手术期风险和生存期延长，对于伴有动脉侵犯的胰腺癌患者，包括动脉切除在内的根治性切除是合理的。
