Abstract:

Clinical efficacy and safety of distal pancreatectomy with celiac axis resection for pancreatic body/tail cancer              SHI Li-gang*，JI Meng，CHEN Jun，et al. *Department of Pancreatic and Biliary Surgery，Changzheng Hospital，the Second Military Medical University，Shanghai 200003，China
Corresponding author：SHAO Cheng-hao，E-mail:13801938229@163.com
Abstract    Objective    To analyze the efficacy and safety of distal pancreatectomy with celiac axis resection for pancreatic body/tail cancer. Methods    The clinicopathological data of 126 patients with pancreatic body/tail cancer who underwent distal pancreatectomy with R0 resection and without distant metastasis from 2010 to 2014 in Department of Pancreatic Surgery，Changhai Hospital，the Second Military Medical University were reviewed retrospectively. The same surgical group performed distal pancreatectomy with celiac axis resection（DP-CAR）for 31 patients and standard distal pancreatectomy（DP）for 95 patients. Results    Compared with DP group，more patients with pT3-T4 stage in DP-CAR group（85.7% vs. 43.9%，P<0.001），and more patients were borderline resectable pancreatic cancer （BRPC） in DP-CAR group （87.1% vs. 5.3%，P<0.001）. The operation time [（134.4±28.6）min vs.（111.8±38.1）min，P=0.004] and postoperative length of hospital stay [（16.2±11.0）d vs. （8.4±2.7）d，P<0.001] were significantly longer in the DP-CAR group. Grade C pancreatic fistulas (19.4% vs. 2.1%，P=0.003) and postoperative hemorrhages（19.4% vs. 3.2%，P=0.007） were significantly more in DP-CAR group. Two patients in DP-CAR group died because of postoperative hemorrhages. The median survival time （MST）after DP-CAR and DP were 19 months and 20 months（P=0.652）. Conclusion    DP-CAR offers high resection rate for patients with borderline resectable pancreatic body/tail cancer, and postoperative complication rate and morbidity are higher than those in DP. Some patients can benefit from DP-CAR.

Key words: celiac axis, distal pancreatectomy, borderline resectable pancreatic carcinoma (BRPC), complication

摘要：

目的    探讨联合腹腔干切除的胰体尾癌根治术（DP-CAR）的疗效、安全性及应用价值。方法  回顾性分析2010—2014年第二军医大学附属长海医院胰腺外科同一手术组收治的R0切除的126例胰体尾癌病人的临床资料，均无远处转移，其中行DP-CAR 31例，行传统胰体尾癌根治术（DP）95例。结果    DP-CAR组病人T3～T4期比例（85.7% vs. 43.9%，P<0.001）和可能切除胰腺癌比例（87.1% vs. 5.3%，P<0.001）均明显高于DP组。DP-CAR组手术时间［（134.4±28.6）min vs. （111.8±38.1）min，P=0.004］及术后住院时间［（16.2±11.0）d vs. （8.4±2.7）d，P<0.001］较DP组明显延长。DP-CAR组病人术后C级胰瘘（19.4% vs. 2.1%，P=0.003）及术后出血（19.4% vs. 3.2%，P=0.007）发生率明显高于DP组，且有2例病人因胰瘘继发腹腔出血死亡。DP-CAR组与DP组病人术后中位生存时间分别为19个月和20个月，两组差异无统计学意义（P=0.652）。结论    DP-CAR可提高可能切除胰体尾癌手术切除率，手术疗效满意，可使部分病人获益，但术后并发症发生率及病死率高于DP，手术风险相对较高。

关键词: 腹腔干, 胰体尾癌根治术, 可能切除胰腺癌, 并发症