胰切除术加静脉切除术：东西方两大机构的经验。

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-03-01 DOI:10.1016/j.pan.2025.01.007

Atsushi Oba , Kimitaka Tanaka , Yosuke Inoue , Roberto Valente , Elena Rangelova , Urban Arnelo , Yoshihiro Ono , Takafumi Sato , Robert J. Torphy , Hiromichi Ito , Matthias Löhr , Yu Takahashi , Richard D. Schulick , Akio Saiura , Ernesto Sparrelid , Marco Del Chiaro

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引用次数: 0

摘要

背景：胰腺癌胰切除术联合静脉切除（PAVR）的有效性和首选重建方法，特别是广泛的门静脉/肠系膜上静脉（PV/SMV）切除（大于4cm），仍然是争论的主题。本研究的目的是通过分析两家来自不同地区的大型机构的数据来评估PAVR的安全性和可行性。方法：2008年至2018年，我们在瑞典卡罗林斯卡大学医院（KUH）和日本癌症研究基金会癌症研究所医院（JFCR）连续筛选了一系列接受PAVR治疗的胰腺癌患者。两家机构均采用动脉优先入路，以提高手术精度。本研究比较了两个中心的短期和长期结果、静脉切除类型和重建方法。结果：共鉴定出506例PAVR患者，其中KUH 211例，JFCR 295例。KUH的全胰切除术发生率较高（24.6% vs 0.3%）。术中估计失血量（KUH: 630 ml, JFCR: 600 ml）、严重并发症发生率（8.5%,5.1%）和死亡率（2.4%,0.7%）差异无统计学意义。即使PV/SMV切除长度为5cm或更长，也主要进行初级端到端吻合，并取得了可接受的通畅性(无血栓率：总体病例，98.0%；5厘米以上（93.5%）。结论：我们报告了来自东部和西部两个高容量中心的胰腺癌PAVR治疗的良好结果。即使PV/SMV切除长度为5cm或更长，一期端到端吻合也是安全可行的。

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Pancreatectomies with vein resection: Two large institutions’ experience of East and West

Background

The effectiveness and preferred reconstruction methods of pancreatectomy associated with vein resection (PAVR) for pancreatic cancer, especially for the extensive portal vein/superior mesenteric vein (PV/SMV) resections (more than 4 cm), are still subjects of debate. The aim of this study is to evaluate the safety and feasibility of PAVR by analyzing data from two large institutions from different regions.

Methods

From 2008 to 2018, we identified consecutive series of patients with pancreatic cancer who underwent PAVR at Karolinska University Hospital (KUH), Sweden, and Cancer Institute Hospital, Japanese Foundation of Cancer Research (JFCR), Japan. Both institutions adopted the artery-first approach to enhance surgical precision. This study compared the short- and long-term outcomes, vein resection types, and reconstruction methods between the two centers.

Results

A total of 506 patients who underwent PAVR were identified, 211 patients were from KUH and 295 patients were from JFCR. A higher incidence of total pancreatectomy was identified at KUH (24.6 % vs 0.3 %). There were no significant differences in intraoperative estimated blood loss (KUH: 630 ml, JFCR: 600 ml), severe complications rate (8.5 %, 5.1 %), and mortality (2.4 %, 0.7 %). Primary end-to-end anastomosis was primarily performed even if the length of PV/SMV resection was 5 cm or more and achieved successfully with acceptable patency (No thrombus rate: overall cases, 98.0 %; 5 cm or more, 93.5 %).

Conclusions

We report favorable outcomes of PAVR for pancreatic cancer from two high-volume centers in the east and west. Primary end-to-end anastomosis was safe and feasible even if the length of PV/SMV resection was 5 cm or more.

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.