Nagakawa T, Konishi I, Ueno K, Ohta T, Kayahara M, Miyazaki I
Second Department of Surgery (Department of Health Science), School of Medicine, Kanazawa University, Japan.
Hepatogastroenterology. 1998 May-Jun;45(21):849-54.
BACKGROUND/AIMS: Pancreatic cancer has a poor prognosis, which is, in part due, to the unfortunately advanced stage, in which the tumor is diagnosed. Since 1973, we have utilized a unique method of extended radical pancreatectomy, using the translateral retroperitoneal approach (TRA) to facilitate combined portal resection. The advantages of this operation are described herein, for patients with carcinoma of the head of the pancreas. In addition, the problems associated with this operation are discussed.
Survival was calculated based on type of resection, degree of invasion of the retroperitoneal tissues, degree of lymph node involvement, and cancer stage. Extensive surgery has been performed for pancreatic carcinoma 216 patients. Of these, 14 patients had carcinoma of the head of the pancreas. There were 58 patients who underwent macroscopically curative resections.
Only 39 patients were microscopically curative. Ten of the patients who underwent microscopically curative resections, survived for 5 years (34.0%). There were no statistically significant differences in survival based on tumor size. However, there was a significant difference in survival based on extent of invasion of the anterior capsule of the pancreas, extent of invasion of the retroperitoneal tissue, extent of lymph node involvement, cancer stage, and extent of invasion at the surgical margin of resection.
The results suggest that extended radical pancreatectomy may be indicated for the treatment of cancer of the head of the pancreas.
背景/目的：胰腺癌预后较差，部分原因是肿瘤确诊时已处于晚期。自1973年以来，我们采用一种独特的扩大根治性胰腺切除术方法，即经侧腹膜后入路（TRA），以利于联合门静脉切除。本文描述了该手术对胰头癌患者的优势。此外，还讨论了与该手术相关的问题。
根据切除类型、腹膜后组织侵犯程度、淋巴结受累程度和癌症分期计算生存率。对216例胰腺癌患者进行了广泛手术。其中，14例为胰头癌。58例患者接受了肉眼下根治性切除。
仅39例患者显微镜下切缘阴性。10例显微镜下切缘阴性的患者存活了5年（34.0%）。基于肿瘤大小的生存率无统计学显著差异。然而，基于胰腺前包膜侵犯程度、腹膜后组织侵犯程度、淋巴结受累程度、癌症分期以及切除手术切缘侵犯程度的生存率存在显著差异。
结果表明，扩大根治性胰腺切除术可能适用于胰头癌的治疗。
