Impact of the radiological morphology of the mesopancreas on the outcome after pancreatoduodenectomy for pancreatic ductal adenocarcinoma: retrospective study.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-10-29 DOI:10.1093/bjsopen/zrae134
Julie Navez, Martina Pezzullo, Christelle Bouchart, Tatjana Arsenijevic, Pieter Demetter, Jean Closset, Oier Azurmendi Senar, Marie-Lucie Racu, Nicky D'Haene, Jacques Devière, Laurine Verset, Maria A Bali, Jean-Luc van Laethem
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引用次数: 0

Abstract

Background: The most frequently invaded margins on pancreatoduodenectomy specimens for pancreatic ductal adenocarcinoma are vascular margins, particularly the superior mesenteric artery (or mesopancreatic) margin. Due to limited exploration of the radiological aspect of the mesopancreas, the aim of this study was to evaluate mesopancreatic infiltration through imaging of patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy, to correlate these findings with histopathology and evaluate their impact on survival.

Methods: Data for all patients who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma from 2015 to 2021 were reviewed, including review of surgical margin histopathology and blinded review of preoperative diagnostic imaging. According to qualitative radiological assessment, the mesopancreas was characterized as having normal fat, fat stranding, or solid infiltration. Survival data were analysed using Cox regression.

Results: A total of 149 patients were included. At baseline imaging, mesopancreatic fat stranding or solid infiltration was present in 47 patients (31.5%) and 20 patients (13.4%) respectively. Median overall survival and disease-free survival were significantly lower with mesopancreatic solid infiltration (17 and 8 months) compared with normal fat (30 and 14 months) and fat stranding (29 and 16 months) (P = 0.017 and 0.028 respectively). In multivariable analysis, pathological tumour size was an independent prognostic factor for overall survival, and tumour location in the uncinate process and pathological tumour size were independent prognostic factors for disease-free survival.

Conclusion: At diagnostic imaging, solid infiltration (but not fat stranding) of the mesopancreas is associated with a poor prognosis for pancreatic ductal adenocarcinoma patients who undergo pancreatoduodenectomy. Pathological tumour size significantly influences the prediction of overall survival, and tumour location in the uncinate process and pathological tumour size significantly influence the prediction of disease-free survival, suggesting further exploration of underlying mechanisms related to retroperitoneal tumoral invasion of vascular margins and the mesopancreas.

胰腺间质放射学形态对胰腺十二指肠切除术治疗胰腺导管腺癌疗效的影响:回顾性研究。
背景:胰腺导管腺癌胰十二指肠切除术标本最常侵犯的边缘是血管边缘,尤其是肠系膜上动脉(或胰腺间质)边缘。由于对胰腺间质放射学方面的探索有限,本研究旨在通过对接受胰十二指肠切除术的胰腺导管腺癌患者进行成像评估胰腺间质浸润情况,将这些发现与组织病理学相关联,并评估其对生存率的影响:对2015年至2021年期间因胰腺导管腺癌接受胰十二指肠切除术的所有患者的数据进行回顾,包括手术边缘组织病理学回顾和术前诊断成像的盲法回顾。根据定性放射学评估,胰腺间质被定性为正常脂肪、脂肪绞窄或实性浸润。采用考克斯回归法分析生存数据:结果:共纳入 149 名患者。在基线成像中,分别有47名患者(31.5%)和20名患者(13.4%)出现胰腺间质脂肪搁浅或实性浸润。胰腺间质实性浸润的中位总生存期和无病生存期(17 个月和 8 个月)明显低于正常脂肪(30 个月和 14 个月)和脂肪搁浅(29 个月和 16 个月)(P = 0.017 和 0.028)。在多变量分析中,病理肿瘤大小是总生存期的独立预后因素,肿瘤位置在钩突和病理肿瘤大小是无病生存期的独立预后因素:结论:在胰腺十二指肠切除术的诊断成像中,胰腺间质的实性浸润(而非脂肪串)与胰腺导管腺癌患者的不良预后有关。病理肿瘤大小对总生存率的预测有明显影响,肿瘤位于脐突处和病理肿瘤大小对无病生存率的预测有明显影响,这表明需要进一步探索腹膜后肿瘤侵犯血管边缘和胰腺间质的相关机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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