确定胰腺十二指肠切除术和胰腺导管腺癌淋巴腺扩大切除术的合适人选

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-10-01 DOI:10.1016/j.hpb.2024.07.405

Jiali Yang, Junfeng Zhang, Mingda Tan, Jianyou Gu, Li Tang, Yao Zheng, Qiang Zhou, Xianxing Wang, Renpei Xia, Tao Zhang, Yongjun Yang, Shixiang Guo, Huaizhi Wang

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引用次数: 0

摘要

背景评估胰腺十二指肠切除术（PDAC）伴扩大淋巴结切除术（PDEL）后胰腺导管腺癌（PDAC）患者的长期生活质量和生存率，并确定候选患者.方法可切除的PDAC患者在胰腺十二指肠切除术（PD）中检查出≥1个淋巴结（LN），分为标准淋巴结切除术（PDSL）组和PDEL组。结果筛查了 446 例 PDAC 患者，PDSL 组和 PDEL 组分别有 237 例和 126 例患者。PDEL 组的手术时间更长、术中失血量更大、腹泻更严重、III 级并发症发生率更高。值得注意的是，PDEL 患者的腰背痛和腹泻症状明显缓解，生存率明显提高（P = 0.037），尤其是术前肿瘤与血管有接触且病理结果为 N0 的患者；然而，LNs+ 在任何部位（8p、12、14 或 16 号）都与较差的预后有关。结论PDEL能缓解PDAC患者的症状并延长其生存期，且并发症可接受，无论术前LN是否增大，都应进行EL。

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Identifying suitable candidates for pancreaticoduodenectomy with extended lymphadenectomy for pancreatic ductal adenocarcinoma

Background

To evaluate long-term quality of life and survival in pancreatic ductal adenocarcinoma (PDAC) patients after pancreatoduodenectomy with extended lymphadenectomy (PDEL) and identify candidates.

Methods

Patients with resectable PDAC with ≥1 examined lymph node (LN) during pancreatoduodenectomy (PD), and were divided into the PD with standard lymphadenectomy (PDSL) and PDEL groups. Perioperative data, long-term quality of life and survival were compared, and the prognostic effect of LNs ± in every peripancreatic station were analysed.

Results

Screening 446 PDAC patients, 237 and 126 were included in the PDSL and PDEL groups, respectively. The PDEL group showed a longer operation time, greater intraoperative blood loss, severe diarrhoea, a higher incidence of grade III complications. Notably, the PDEL patients experienced significant relief from low back pain and diarrhoea, with an obvious survival advantage (p = 0.037), especially in patients with preoperative tumor contact with vascular and pathological N0; however, LNs+ in any station (No. 8p, 12, 14, or 16) were associated with a poorer prognosis. The vascular reconstruction, T and N stage were independent risk factors for survival.

Conclusion

PDEL can relieve symptoms and prolong the survival of PDAC patients with acceptable complications, and EL should be performed regardless of preoperative LN enlargement.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).