Yang Feng, Xu Yecheng, Jin Chen, He Hang, Li Ji, Fu Deliang
Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Surgery. 2025 Aug;184:109412. doi: 10.1016/j.surg.2025.109412. Epub 2025 May 20.
Literature on factors influencing prognosis after periarterial divestment for borderline resectable or locally advanced pancreatic ductal adenocarcinoma and preventative measures for postpancreatectomy hemorrhage is scarce. This study aimed to evaluate the efficacy of Neuro-Patch for arterial reinforcement in preventing postpancreatectomy hemorrhage and explore the oncologic outcomes of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma following periarterial divestment.
We conducted a retrospective analysis of 125 patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma involving arteries who underwent periarterial divestment between January 2018 and May 2022.
Among the study cohort, 54 patients underwent pancreaticoduodenectomy, 43 had distal pancreatectomy, and 28 received total pancreatectomy, with 74 patients also undergoing combined venous resection. Periarterial divestment was performed on the hepatic artery in 47 patients, the celiac artery in 3, the superior mesenteric artery in 22, and multiple arteries in 53. Neoadjuvant chemotherapy was administered to 24% of patients, with an R0 resection rate of 33.6%. The median postoperative hospital stay was 10 days, with a 90-day mortality rate of 3.2%. Neuro-Patch was used in 51 patients, leading to a significant reduction in postpancreatectomy hemorrhage (odds ratio 0.073, 95% confidence interval 0.007-0.783, P = .031). The median overall survival was 20.6 months, with 1- and 3-year survival rates estimated at 73.2% and 22.9%, respectively. Neoadjuvant chemotherapy (hazard ratio 0.494, 95% confidence interval 0.291-0.839, P = .009) and venous invasion (hazard ratio 2.041, 95% confidence interval 1.308-3.186, P = .002) emerged as independent predictors of overall survival.
Neoadjuvant chemotherapy significantly enhances survival outcomes of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma undergoing periarterial divestment, and it should be regarded as a standard preoperative approach. The Neuro-Patch provides structural reinforcement to the arterial wall, potentially reducing the risk of postpancreatectomy hemorrhage. However, randomized controlled trials are necessary to substantiate its efficacy and safety.
关于影响临界可切除或局部晚期胰腺导管腺癌动脉周围剥离术后预后的因素以及胰十二指肠切除术后出血预防措施的文献较少。本研究旨在评估Neuro-Patch用于动脉加固预防胰十二指肠切除术后出血的疗效，并探讨临界可切除或局部晚期胰腺导管腺癌患者动脉周围剥离术后的肿瘤学结局。
我们对2018年1月至2022年5月期间125例涉及动脉的临界可切除或局部晚期胰腺导管腺癌患者进行了回顾性分析，这些患者均接受了动脉周围剥离术。
在研究队列中，54例患者接受了胰十二指肠切除术，43例接受了胰体尾切除术，28例接受了全胰切除术，其中74例患者还接受了联合静脉切除术。47例患者对肝动脉进行了动脉周围剥离，3例对腹腔干动脉进行了剥离，22例对肠系膜上动脉进行了剥离，53例对多条动脉进行了剥离。24%的患者接受了新辅助化疗，R0切除率为33.6%。术后中位住院时间为10天，90天死亡率为3.2%。51例患者使用了Neuro-Patch，导致胰十二指肠切除术后出血显著减少（比值比0.073，95%置信区间0.007-0.783，P = .031）。中位总生存期为20.6个月，1年和3年生存率分别估计为73.2%和22.9%。新辅助化疗（风险比0.494，95%置信区间0.291-0.839，P = .009）和静脉侵犯（风险比2.041，95%置信区间1.308-3.186，P = .002）成为总生存期的独立预测因素。
新辅助化疗显著提高了接受动脉周围剥离的临界可切除或局部晚期胰腺导管腺癌患者的生存结局，应将其视为标准的术前治疗方法。Neuro-Patch为动脉壁提供结构加固，可能降低胰十二指肠切除术后出血的风险。然而，需要进行随机对照试验来证实其疗效和安全性。
