Alessiani M, Tzakis A, Todo S, Demetris A J, Fung J J, Starzl T E
Pittsburgh Transplant Institute, University of Pittsburgh Medical Center, PA.
J Am Coll Surg. 1995 Jan;180(1):1-9.
Upper abdominal exenteration (resection of the liver, stomach, spleen, pancreaticoduodenal complex, and part of the colon) for the treatment of otherwise unresectable tumors is one of the more radical operations in oncology. This study was done to analyze retrospectively a five-year experience with exenteration in 57 patients treated with variations of resectional and transplant reconstructive techniques.
Sixty-one transplantations were performed upon 57 patients. Three different organ replacement techniques were used: liver-pancreas-duodenum en bloc (original procedure), liver only (modified procedure), and liver plus pancreatic islets. The diagnoses were cholangiocarcinoma (20 patients), hepatocellular carcinoma (12 patients), endocrine neoplasms (14 patients), sarcoma (six patients), and adenocarcinoma of the pancreas (two patients), colon (two patients), or gallbladder (one patient). Analyses of survival and tumor recurrence were stratified by procedure variations, type and extent of tumor, and immunosuppressive regimen.
The three month and one, two, three, and five year actuarial patient survival rates were 82, 56, 38, 33, and 30 percent, respectively. Eighteen (31.5 percent) of the 57 patients are alive after 425 15 (standard deviation) months (range of 17 to 61 months) and 12 patients are tumor free. The actuarial survival rates stratified by transplantation procedure, immunosuppression, and tumor diagnosis and extent showed no statistically significant differences beyond the three different transplantation groups. Endocrine tumors had a better three-year survival rate (64 percent) than sarcoma (44 percent), hepatocellular carcinoma (25 percent), cholangiocarcinoma (20 percent), and the other adenocarcinomas (20 percent). Twenty-three patients (40 percent) died as a result of tumor recurrence. Patients with combined factors of no lymph node involvement, absence of vascular invasion, and metastases to the liver only (11 patients) had the lowest incidence of recurrence (27 compared to 73.5 percent, p = 0.006).
Patients with unresectable endocrine neoplasms, fibrolamellar hepatocellular carcinoma, and selected cholangiocarcinoma confined to the liver can benefit from this radical operative approach. Patients with sarcoma can achieve long survival periods but have a high recurrence rate.
上腹部脏器清除术（切除肝脏、胃、脾脏、胰十二指肠复合体及部分结肠）用于治疗其他方法无法切除的肿瘤，是肿瘤学中较为激进的手术之一。本研究旨在回顾性分析57例采用不同切除和移植重建技术进行脏器清除术的患者的五年经验。
对57例患者进行了61次移植手术。采用了三种不同的器官置换技术：肝-胰-十二指肠整块移植（原手术方法）、仅肝移植（改良手术方法）和肝加胰岛移植。诊断包括胆管癌（20例）、肝细胞癌（12例）、内分泌肿瘤（14例）、肉瘤（6例）以及胰腺癌（2例）、结肠癌（2例）或胆囊癌（1例）。根据手术方式的差异、肿瘤的类型和范围以及免疫抑制方案对生存率和肿瘤复发情况进行分析。
术后三个月、一年、两年、三年和五年的精算患者生存率分别为82%、56%、38%、33%和30%。57例患者中有18例（31.5%）在425±15（标准差）个月（17至61个月）后仍存活，12例患者无肿瘤复发。根据移植手术方式、免疫抑制情况以及肿瘤诊断和范围分层的精算生存率在三个不同移植组之外无统计学显著差异。内分泌肿瘤的三年生存率（64%）高于肉瘤（44%）、肝细胞癌（25%）、胆管癌（20%）和其他腺癌（20%）。23例患者（40%）死于肿瘤复发。无淋巴结受累、无血管侵犯且仅肝转移的联合因素患者（11例）复发率最低（27%，相比之下为73.5%，p = 0.006）。
无法切除的内分泌肿瘤、纤维板层型肝细胞癌以及局限于肝脏的特定胆管癌患者可从这种根治性手术方法中获益。肉瘤患者可获得较长生存期，但复发率较高。
