Egorov V I, Kotelnikov A G, Patyutko Yu I, Akhmetzyanov F Sh, Podluzhny D V, Polyakov A N, Kudashkin N E, Shaikhutdinov N T
Blokhin National Cancer Research Center, Moscow, Russia.
Kazan State Medical University, Kazan, Russia.
Khirurgiia (Mosk). 2025(8):30-38. doi: 10.17116/hirurgia202508130.
To study the immediate and long-term results of multivisceral surgeries with pancreaticoduodenectomy for gastric cancer.
The 1 group included 24 patients who underwent multivisceral surgeries with pancreaticoduodenectomy for gastric cancer with pancreatic head and/or duodenum invasion. The 2 group included 60 patients with gastric cancer who underwent partial resection of the pancreatic head and/or duodenum rather pancreaticoduodenectomy.
ASA class III was observed in 10 (41.7%) out of 24 patients in the 1 group and in 12 (20.0%) out of 60 patients in the 2 group (=0.041). In group 2, there were no cases of vein invasion (0 versus 12.5%; =0.021). In group 1, Clavien-Dindo grade ≥3 complications were more common (10 (41.7%) vs. 14 (23.3%) cases, =0.005). Moreover, pancreatic fistulas of all classes were more common (9 (37.5%) vs. 9 (15.0%) cases, =0.023). Median overall survival was 15 and 14 months, respectively. Overall five-year survival was 24.1% (95% CI 7.8-45.2) and 8.2% (95% CI 2.3-18.9%), respectively (=0.483). Locoregional recurrence was more common in the 2 group (23 (41.8%) out of 55 vs. 3 (13.6%) out of 23 patients, =0.018). In the 1 group, median overall survival without adjuvant chemotherapy was 13 months (95% CI 5-17), in the group with adjuvant chemotherapy - 37 months (95% CI 14-64). Overall five-year survival was 7.7% (95% CI 5-29.2) and 50.0% (95% CI 13.7-78.5), respectively (=0.003). Median overall survival in the 2 group without adjuvant chemotherapy was 13 months (95% CI 5-17), in the 2 group with chemotherapy - 17 months (95% CI 12-29; =0.016). The risk of death in the 2 group with chemotherapy was lower than in the 1 group without chemotherapy (OR 0.385; 95% CI 0.183-0.809; =0.012). Multivariate analysis in the 1 group revealed that ASA class 3 negatively affected overall survival (OR 3.04; 95% CI 1.04-8.81; =0.040). Multivariate analysis after combining both groups established that negative factors of long-term prognosis were female gender (OR 2.47; 95% CI 1.25-4.87; =0.009), coronary artery disease (OR 3.44; 95% CI 1.16-10.17; =0.025), locoregional recurrence (OR 2.49; 95% CI 1.13-5.50; =0.024) and type B pancreatic fistula (OR 2.68; 95% CI 1.070-6.731; =0.035). Positive factors were multivisceral surgeries with pancreaticoduodenectomy (OR 0.36; 95% CI 0.14-0.86; =0.023) and adjuvant chemotherapy (OR 0.27; 95% CI 0.13-0.57; <0.001).
Multivisceral surgeries with pancreaticoduodenectomy for gastric cancer with pancreatic and/or duodenal invasion is justified in patients with ASA class 1-2 due to higher probability of adjuvant chemotherapy and better survival.
研究胃癌行多脏器联合胰十二指肠切除术的近期和远期效果。
1组包括24例行多脏器联合胰十二指肠切除术治疗侵犯胰头和/或十二指肠的胃癌患者。2组包括60例行胰头和/或十二指肠部分切除而非胰十二指肠切除术的胃癌患者。
1组24例患者中有10例（41.7%）为美国麻醉医师协会（ASA）Ⅲ级，2组60例患者中有12例（20.0%）为ASAⅢ级（P = 0.041）。2组无静脉侵犯病例（0例 vs. 12.5%；P = 0.021）。1组Clavien-Dindo≥3级并发症更常见（10例（41.7%） vs. 14例（23.3%），P = 0.005）。此外，各等级胰瘘均更常见（9例（37.5%） vs. 9例（15.0%），P = 0.023）。中位总生存期分别为15个月和14个月。总体五年生存率分别为24.1%（95%可信区间7.8 - 45.2）和8.2%（95%可信区间2.3 - 18.9%）（P = 0.483）。局部区域复发在2组更常见（55例中的23例（41.8%） vs. 23例中的3例（13.6%），P = 0.018）。1组中，未行辅助化疗的中位总生存期为13个月（95%可信区间5 - 17），行辅助化疗的为37个月（95%可信区间14 - 64）。总体五年生存率分别为7.7%（95%可信区间5 - 29.2）和50.0%（95%可信区间13.7 - 78.5）（P = 0.003）。2组未行辅助化疗的中位总生存期为13个月（95%可信区间5 - 17），行化疗的为17个月（95%可信区间12 - 29；P = 0.016）。2组行化疗的死亡风险低于1组未行化疗的（比值比0.385；95%可信区间0.183 - 0.809；P = 0.012）。1组多因素分析显示ASA 3级对总生存期有负面影响（比值比3.04；95%可信区间1.04 - 8.81；P = 0.040）。两组合并后的多因素分析确定长期预后的负面因素为女性（比值比2.47；95%可信区间1.25 - 4.87；P = 0.009）、冠状动脉疾病（比值比3.44；95%可信区间1.16 - 10.17；P = 0.025）、局部区域复发（比值比2.49；95%可信区间1.13 - 5.50；P = 0.024）和B级胰瘘（比值比2.68；95%可信区间1.070 - 6.731；P = 0.035）。正面因素为多脏器联合胰十二指肠切除术（比值比0.36；95%可信区间0.14 - 0.86；P = 0.023）和辅助化疗（比值比0.27；95%可信区间0.13 - 0.57；P < 0.001）。
对于ASA 1 - 2级患者，胃癌侵犯胰腺和/或十二指肠时行多脏器联合胰十二指肠切除术是合理的，因为辅助化疗概率更高且生存更好。
