David Henault,Holden Kunde,Cody Zatzman,Daniela Bevacqua,Danielle LA Arshinoff,Sean P Cleary,Laura A Dawson,Elena Elimova,Robert Grant,Ali Hosni,Raymond W Jang,Jennifer J Knox,Aruz Mesci,Malcolm Moore,Carol-Anne E Moulton,Trevor W Reichman,Chaya Shwaartz,Erica S Tsang,Ian D McGilvray,Steven Gallinger
{"title":"胰腺癌血管切除术--来自一家高容量中心的十年经验。","authors":"David Henault,Holden Kunde,Cody Zatzman,Daniela Bevacqua,Danielle LA Arshinoff,Sean P Cleary,Laura A Dawson,Elena Elimova,Robert Grant,Ali Hosni,Raymond W Jang,Jennifer J Knox,Aruz Mesci,Malcolm Moore,Carol-Anne E Moulton,Trevor W Reichman,Chaya Shwaartz,Erica S Tsang,Ian D McGilvray,Steven Gallinger","doi":"10.1097/sla.0000000000006567","DOIUrl":null,"url":null,"abstract":"OBJECTIVE BACKGROUND\r\nCombined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR).\r\n\r\nMETHODS\r\nRetrospective review (2011-2023) of 715 PDAC patients treated with curative-intent surgery. Associations among clinicopathological data, perioperative therapy, time to recurrence (TTR), and overall survival (OS) were evaluated.\r\n\r\nRESULTS\r\nInitial staging revealed 533 resectable, 98 borderline, and 84 locally advanced PDAC cases. Pancreaticoduodenectomy was the most common procedure (n=467). NVR was performed in 351 (58.2%) patients, VR in 181 (30.0%), and AR in 70 (11.8%). The median TTR and OS did not significantly differ according to the initial staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 mo) compared to NVR (18.6 and 30.5 mo, P<0.001) and AR (20.6 and 30.9 mo, P=0.004 and P=0.017). Chemotherapy or chemoradiation significantly prolonged TTR (20.1 vs. 10.2 mo, P<0.001 and 25.3 vs. 16.4 mo, P<0.001) and OS (31.5 vs. 17.2 mo, P<0.001 and 35.5 vs. 27.5 mo, P=0.030). AR was associated with higher 90-day mortality rates. In the multivariable analysis, vascular resection was not associated with OS. Perioperative therapy, pathological N0 status, and absence of perineural invasion were the key predictors of longer TTR and OS.\r\n\r\nCONCLUSIONS\r\nPancreatectomy with AR was not associated with worse oncological outcomes when controlling for perioperative therapy. However, AR was associated with higher 90-day mortality rates. Patient selection is crucial when performing AR in patients with PDAC.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Vascular Resection for Pancreas Cancer - 10-year Experience from a Single High Volume-center.\",\"authors\":\"David Henault,Holden Kunde,Cody Zatzman,Daniela Bevacqua,Danielle LA Arshinoff,Sean P Cleary,Laura A Dawson,Elena Elimova,Robert Grant,Ali Hosni,Raymond W Jang,Jennifer J Knox,Aruz Mesci,Malcolm Moore,Carol-Anne E Moulton,Trevor W Reichman,Chaya Shwaartz,Erica S Tsang,Ian D McGilvray,Steven Gallinger\",\"doi\":\"10.1097/sla.0000000000006567\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVE BACKGROUND\\r\\nCombined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR).\\r\\n\\r\\nMETHODS\\r\\nRetrospective review (2011-2023) of 715 PDAC patients treated with curative-intent surgery. Associations among clinicopathological data, perioperative therapy, time to recurrence (TTR), and overall survival (OS) were evaluated.\\r\\n\\r\\nRESULTS\\r\\nInitial staging revealed 533 resectable, 98 borderline, and 84 locally advanced PDAC cases. Pancreaticoduodenectomy was the most common procedure (n=467). NVR was performed in 351 (58.2%) patients, VR in 181 (30.0%), and AR in 70 (11.8%). The median TTR and OS did not significantly differ according to the initial staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 mo) compared to NVR (18.6 and 30.5 mo, P<0.001) and AR (20.6 and 30.9 mo, P=0.004 and P=0.017). Chemotherapy or chemoradiation significantly prolonged TTR (20.1 vs. 10.2 mo, P<0.001 and 25.3 vs. 16.4 mo, P<0.001) and OS (31.5 vs. 17.2 mo, P<0.001 and 35.5 vs. 27.5 mo, P=0.030). AR was associated with higher 90-day mortality rates. In the multivariable analysis, vascular resection was not associated with OS. Perioperative therapy, pathological N0 status, and absence of perineural invasion were the key predictors of longer TTR and OS.\\r\\n\\r\\nCONCLUSIONS\\r\\nPancreatectomy with AR was not associated with worse oncological outcomes when controlling for perioperative therapy. However, AR was associated with higher 90-day mortality rates. 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引用次数: 0
摘要
目的 背景胰腺导管腺癌(PDAC)越来越多地采用胰腺和血管联合切除术。我们评估了非血管切除术(NVR)、静脉切除术(VR)和动脉切除术(AR)胰腺切除术后的预后。结果初步分期显示有533例可切除、98例边缘和84例局部晚期PDAC病例。胰十二指肠切除术是最常见的手术(n=467)。351例(58.2%)患者进行了NVR,181例(30.0%)进行了VR,70例(11.8%)进行了AR。中位 TTR 和 OS 与初始分期或胰腺切除类型无明显差异。与NVR(18.6和30.5个月,P<0.001)和AR(20.6和30.9个月,P=0.004和P=0.017)相比,VR(14.5和22.7个月)的中位TTR和OS明显较短。化疗或放疗可明显延长TTR(20.1个月对10.2个月,P<0.001;25.3个月对16.4个月,P<0.001)和OS(31.5个月对17.2个月,P<0.001;35.5个月对27.5个月,P=0.030)。AR与较高的90天死亡率相关。在多变量分析中,血管切除与OS无关。结论在控制围手术期治疗的情况下,AR胰切除术与较差的肿瘤预后无关。然而,AR与较高的90天死亡率有关。在对PDAC患者进行AR手术时,患者的选择至关重要。
Vascular Resection for Pancreas Cancer - 10-year Experience from a Single High Volume-center.
OBJECTIVE BACKGROUND
Combined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR).
METHODS
Retrospective review (2011-2023) of 715 PDAC patients treated with curative-intent surgery. Associations among clinicopathological data, perioperative therapy, time to recurrence (TTR), and overall survival (OS) were evaluated.
RESULTS
Initial staging revealed 533 resectable, 98 borderline, and 84 locally advanced PDAC cases. Pancreaticoduodenectomy was the most common procedure (n=467). NVR was performed in 351 (58.2%) patients, VR in 181 (30.0%), and AR in 70 (11.8%). The median TTR and OS did not significantly differ according to the initial staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 mo) compared to NVR (18.6 and 30.5 mo, P<0.001) and AR (20.6 and 30.9 mo, P=0.004 and P=0.017). Chemotherapy or chemoradiation significantly prolonged TTR (20.1 vs. 10.2 mo, P<0.001 and 25.3 vs. 16.4 mo, P<0.001) and OS (31.5 vs. 17.2 mo, P<0.001 and 35.5 vs. 27.5 mo, P=0.030). AR was associated with higher 90-day mortality rates. In the multivariable analysis, vascular resection was not associated with OS. Perioperative therapy, pathological N0 status, and absence of perineural invasion were the key predictors of longer TTR and OS.
CONCLUSIONS
Pancreatectomy with AR was not associated with worse oncological outcomes when controlling for perioperative therapy. However, AR was associated with higher 90-day mortality rates. Patient selection is crucial when performing AR in patients with PDAC.
期刊介绍:
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.