Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Cancer. 1993 Oct 1;72(7):2118-23. doi: 10.1002/1097-0142(19931001)72:7<2118::aid-cncr2820720710>3.0.co;2-4.
To determine the extent of dissection in curative resection for cancer of the pancreatic head, the mode of recurrence was determined at autopsy and by radiographic examinations.
Records of 45 patients who had undergone macroscopically curative resection of carcinoma of the head of pancreas were analyzed to determined the mode of recurrence. The mode of recurrence was divided into four types: hepatic metastasis, peritoneal dissemination, retroperitoneal recurrence, and distant metastasis. Retroperitoneal recurrence was subdivided into lymph node metastasis and local recurrence, primarily neural invasion and lymphatic invasion.
Thirty patients experienced disease recurrence. Patients with Stage I or II disease experienced recurrence significantly less often than did patients with Stage III or IV disease (P < 0.05). Local retroperitoneal recurrence was discovered in 12 of 15 (80%) postmortem examinations, hepatic metastasis in 10 (66%), peritoneal dissemination in 8 (53%), and lymph node recurrence in 7 (47%). In 15 antemortem studies, retroperitoneal recurrence occurred most frequently (87%), followed by hepatic metastasis (53%). Almost all patients with liver metastasis also had local retroperitoneal recurrence.
The frequency of retroperitoneal recurrence of carcinoma of the head of the pancreas suggests that retroperitoneal resection, including nerve plexi and lymph nodes, should be included in curative resections for patients with Stage I or II pancreatic cancer.
为确定胰头癌根治性切除术中的解剖范围，通过尸检和影像学检查确定复发模式。
分析45例行胰头癌肉眼根治性切除术患者的记录，以确定复发模式。复发模式分为四种类型：肝转移、腹膜播散、腹膜后复发和远处转移。腹膜后复发又细分为淋巴结转移和局部复发，主要是神经侵犯和淋巴侵犯。
30例患者出现疾病复发。I期或II期疾病患者的复发频率明显低于III期或IV期疾病患者（P<0.05）。15例尸检中有12例（80%）发现局部腹膜后复发，10例（66%）有肝转移，8例（53%）有腹膜播散，7例（47%）有淋巴结复发。在15例生前研究中，腹膜后复发最常见（87%），其次是肝转移（53%）。几乎所有肝转移患者也有局部腹膜后复发。
胰头癌腹膜后复发的频率表明，对于I期或II期胰腺癌患者，根治性切除应包括腹膜后切除，包括神经丛和淋巴结。
