Acs Miklos, Zustin Jozef, Bogovic Niklas, Piso Pompiliu, Blaj Sebastian
Department of Surgery, University Medical Center Regensburg, D-93053, Regensburg, Germany.
Gerhard Domagk Institute of Pathology, University Medical Center Münster, D-48149, Münster, Germany.
World J Surg Oncol. 2025 Jul 24;23(1):300. doi: 10.1186/s12957-025-03954-4.
Distal pancreatic resection during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare, with limited knowledge available. Therefore, a retrospective observational study was conducted using the data registry of a single institution to identify patients that underwent distal pancreatic resection during CRS + HIPEC.
All resected pancreatic specimens were examined for invasive parenchymal tumor infiltration. Pre-, peri-, and postoperative variables and their associations were analyzed.
Over a period of more than a decade, 31 of 1275 patients (2.43%) underwent distal pancreatic resection as part of CRS. Infiltration of the pancreatic parenchyma was confirmed in almost one-third (29.03%) of the cases. Postoperative pancreatic fistulas occurred in 25.81% of patients (87.5% Grade B; 12.5% Grade C). The need for distal pancreatic resection was closely related to tumor burden in the left upper abdomen, with 87% of patients requiring peritonectomy of the left upper abdomen in addition to visceral resection. Pancreatic infiltration (n = 9/31) was diagnosed in 3 cases of gastric carcinoma, 2 cases of colorectal carcinoma, 2 cases of primary peritoneal carcinoma, 1 case of ovarian carcinoma, and 1 case of mucinous appendiceal carcinoma. Postoperative pancreatic fistulas were more frequently associated with primary tumors of the large intestine (87.50% vs. 30.43%; P = 0.0094), and a tendentiously longer total hospital stay was required for the "with pancreatic fistula" group (32.50 ± 19.93 days vs. 21.78 ± 10.14 days), with no impact on patient survival.
Accepting a slightly increased morbidity, distal pancreatic resection is a reasonable approach to achieve complete macroscopic tumor resection. Nonetheless, our study shows that apparent tumor invasion is histologically rare in cases with favorable tumor biology, such as low-grade pseudomyxoma peritonei. Therefore, pancreatic resection should be avoided in cases of mucinous tumors to prevent fistula formation.
在肿瘤细胞减灭术（CRS）及热灌注化疗（HIPEC）期间行胰体尾切除术很少见，相关知识有限。因此，本研究利用单机构数据登记系统进行回顾性观察研究，以确定在CRS+HIPEC期间接受胰体尾切除术的患者。
对所有切除的胰腺标本进行侵袭性实质肿瘤浸润检查。分析术前、术中和术后变量及其相关性。
在十多年的时间里，1275例患者中有31例（2.43%）接受了胰体尾切除术作为CRS的一部分。近三分之一（29.03%）的病例证实有胰腺实质浸润。25.81%的患者发生术后胰瘘（87.5%为B级；12.5%为C级）。胰体尾切除术的必要性与左上腹肿瘤负荷密切相关，87%的患者除了行脏器切除外还需要行左上腹腹膜切除术。在3例胃癌、2例结直肠癌、2例原发性腹膜癌、1例卵巢癌和1例黏液性阑尾癌中诊断出胰腺浸润（n=9/31）。术后胰瘘与大肠原发性肿瘤更相关（87.50%对30.43%；P=0.0094），“有胰瘘”组的总住院时间往往更长（32.50±19.93天对21.78±10.14天），但对患者生存无影响。
尽管发病率略有增加，但胰体尾切除术是实现肿瘤肉眼完全切除的合理方法。然而，我们的研究表明，在肿瘤生物学行为良好的病例中，如低度腹膜假黏液瘤，明显的肿瘤侵犯在组织学上很少见。因此，对于黏液性肿瘤应避免行胰腺切除术以防止瘘的形成。
