Allema J H, Reinders M E, van Gulik T M, van Leeuwen D J, de Wit L T, Verbeek P C, Gouma D J
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Br J Surg. 1994 Nov;81(11):1642-6. doi: 10.1002/bjs.1800811126.
Of 176 patients with carcinoma of the pancreatic head region 156 underwent standard pancreatoduodenectomy (group 2) and 20 with macroscopic suspicion of invasion of the portal vein or superior mesenteric vein (SMV) underwent pancreatoduodenectomy with partial resection of the portal vein or SMV (group 1). In 16 patients in group 1 end-to-end anastomosis was used for reconstruction of the vein. The morbidity rate in groups 1 and 2 was similar (55 versus 63 per cent). The hospital mortality rate was 15 per cent in group 1 and 7 per cent in group 2 (P = 0.22). Histological examination confirmed tumour invasion of the portal vein or SMV in ten patients in group 1. Invasion of the portal vein or SMV was significantly more frequent in patients with pancreatic cancer than in those with distal bile duct or ampullary carcinoma. Of the 20 patients in group 1 only three underwent curative resection with tumour-free margins. The median survival time after resection of the portal vein or SMV was 8 months; the 2-year survival rate was 19 per cent. Comparison of survival in group 1 with survival in subgroups of patients undergoing standard pancreatoduodenectomy, matched for all histological parameters, showed no significant difference. It is concluded that partial resection of the portal vein or SMV in patients undergoing pancreatoduodenectomy who are suspected of having tumour invasion of the portal vein or SMV does not improve either the rate of curative resection or survival.
在176例胰头区域癌患者中，156例行标准胰十二指肠切除术（第2组），20例肉眼怀疑门静脉或肠系膜上静脉（SMV）受侵者行门静脉或SMV部分切除的胰十二指肠切除术（第1组）。第1组中有16例患者行静脉端端吻合重建。第1组和第2组的发病率相似（分别为55%和63%）。第1组的医院死亡率为15%，第2组为7%（P = 0.22）。组织学检查证实第1组中有10例患者肿瘤侵犯门静脉或SMV。胰腺癌患者门静脉或SMV受侵明显比远端胆管癌或壶腹癌患者更常见。第1组的20例患者中只有3例行切缘无肿瘤的根治性切除。门静脉或SMV切除后的中位生存时间为8个月；2年生存率为19%。将第1组的生存率与所有组织学参数匹配的标准胰十二指肠切除术患者亚组的生存率进行比较，未显示出显著差异。得出的结论是，对于怀疑门静脉或SMV有肿瘤侵犯而行胰十二指肠切除术的患者，门静脉或SMV部分切除并不能提高根治性切除率或生存率。
