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胰腺癌术后局部复发再手术切除临床价值研究

吴鹏飞，张    凯，陆子鹏，陈建敏，奚春华，卫积书，郭    峰，蔡宝宝，尹    杰，蒋奎荣，苗    毅   

  1. 南京医科大学第一附属医院（江苏省人民医院）胰腺中心  南京医科大学胰腺研究所，江苏南京210029
  • 出版日期:2021-08-01 发布日期:2021-08-10

  • Online:2021-08-01 Published:2021-08-10

摘要： 目的    探讨胰腺癌术后局部复发再手术切除的临床价值。方法    回顾性分析2014年10月至2021年2月在南京医科大学第一附属医院胰腺中心施行的胰腺癌术后局部复发行再手术切除的20例病人临床资料（再手术切除组），选取同期胰腺癌术后发现局部复发且复发时间≥9个月后未行手术治疗的20例病人作为对照组。分析再手术切除组术中、术后情况，比较分析两组病人生存时间的差异。结果    再手术切除组再手术方式为保留幽门的胰十二指肠切除术（PPPD）3例，标准胰十二指肠切除术（PD）2例，胰体尾切除术（DP）9例，复发灶局部切除术6例；手术时间为210.0（78.0）min（100.0～320.0 min），术中出血量200（188）mL（50～600 mL），术中输血率5.0%（1/20）。术后住院时间为12.5（9.5）d（7.0～49.0 d），术后并发症发生率为30.0%（6/20）；无围手术期死亡；16例再次手术后行辅助化疗。再手术切除组术后病理学检查结果：复发肿瘤直径为2.6（1.1）cm（1.3～6.0 cm）；T分期：T1期 2例，T2期8例，T3期3例，T4期7例；N分期：N0期14例，N1期6例；肿瘤分化程度：中分化7例，低分化13例；环周切缘评估：R0切除9例，R1切除11例。术后生存：再手术切除组末次随访8例死亡，12例存活，首次术后中位总体生存时间为52.2个月，复发后中位生存时间为21.9个月。对照组20例病人末次随访18例死亡，2例存活，首次术后中位总体生存时间为21.9个月，复发后中位生存时间为10.5个月；再手术切除组首次术后总体生存时间（χ2=20.84，P<0.0001）和复发后生存时间（χ2=6.23，P=0.013）均优于对照组，差异均有统计学意义。结论    胰腺癌术后局部复发后再手术切除安全、有效，对术后9个月及以上的局部复发病例行再手术切除可能延长病人生存时间，值得进一步扩大样本量研究。

关键词: 胰腺癌, 局部复发, 手术治疗, 生存时间

Abstract: Clinical value of re-resection for isolated local recurrence of pancreatic cancer        WU Peng-fei，ZHANG Kai，LU Zi-peng，et al.Pancreas Center，the First Affiliated Hospital of Nanjing Medical University，Jiangsu province hospital，Pancreas Institute of Nanjing Medical University，Nanjing 210029，China
Corresponding authors: JIANG Kui-rong,E-mail:jiangkuirong@njmu.edu.cn; MIAO Yi ,E-mail: miaoyi@njmu.edu.cn
WU Peng-fei and ZHANG Kai are the first authors who contributed equally to this article
Abstract    Objective    To evaluate the clinical value of re-resection for isolated local recurrence of postoperative pancreatic cancer. Methods    A total of 20 patients who underwent re-resection of isolated local recurrence (re-resection group) at Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from October 2014 to February 2021 was analyzed retrospectively. The 20 patients who diagnosed as isolated local recurrence with interval ≥9 months from resection to recurrence in the same period were selected as the control group. Intraoperative and postoperative conditions of the re-resection group were analyzed, and the difference in survival time between the two groups was compared. Results    In the re-resection group, pylorus-preserving pancreaticoduodenectomy (PPPD) was performed in 3 cases, standard pancreaticoduodenectomy (PD) in 2 cases, distal pancreatectomy (DP) in 9 cases, and local excision in 6 cases. The operative time was 210.0 (78.0) min (range: 100.0-320.0 min), the intraoperative blood loss was 200 (188) mL (range: 50 -600 mL), and the intraoperative blood transfusion rate was 5.0% (1/20). The postoperative hospital stay was 12.5 (9.5) d (range: 7.0-49.0 d), and the incidence of postoperative complications was 30.0% (6/20). There was no perioperative death. Sixteen patients received adjuvant chemotherapy after reoperation. Pathological results: the diameter of the recurrent tumor was 2.6 (1.1) cm (range: 1.3- 6.0 cm); the T stage: T1 in 2 cases, T2 in 8 cases, T3 in 3 cases and T4 in 7 cases; the N stage: N0 in 14 cases, N1 in 6 cases; the tumor differentiation: moderately differentiated in 7 cases, poorly differentiated in 13 cases; the surgical margins: R0 resection in 9 cases, R1 resection in 11 cases. Follow-up situations: In resection group ,8 cases died and 12 cases survived at the last follow-up,the median overall survival was 52.2 months after the first operation and 21.9 months after local recurrence.In control group, 18 patients died and 2 patients survived at the last follow-up,the median overall survival after the first operation was 21.9 months, and 10.5 months after local recurrence. The overall survival after the first operation (χ2=20.84, P< 0.0001) and the survival after local recurrence (χ2= 6.23，P=0.013) in the re-resection group were longer than those in the control group, and the differences were statistically significant. Conclusion    Re-resection for isolated local recurrence of pancreatic cancer is safe and effective. Re-resection may prolong the survival time of patients with interval ≥9 months from the first operation to local recurrence, which is worthy of further study with extended sample size.

Key words: pancreatic cancer, local recurrence, surgical treatment, survival time