医学
胰十二指肠切除术
外科
养生
新辅助治疗
围手术期
腺癌
远端胰腺切除术
胰腺切除术
叶黄素
内科学
切除术
癌症
伊立替康
结直肠癌
乳腺癌
作者
Abdallah Al Faraï,Jonathan Garnier,Jacques Ewald,Ugo Marchese,Marine Gilabert,Laurence Moureau-Zabotto,Flora Poizat,Marc Giovannini,Jean‐Nicolas Vauthey,Olivıer Turrini
出处
期刊:Ejso
[Elsevier]
日期:2019-10-01
卷期号:45 (10): 1912-1918
被引量:21
标识
DOI:10.1016/j.ejso.2019.06.003
摘要
A new neoadjuvant regimen, together with more aggressive surgeries, appears to have increased the resectability rate in patients with pancreatic ductal adenocarcinoma (PDAC). Our study aimed to evaluate the outcomes of patients who underwent venous resection (VR) during pancreatectomies for PDAC.Between 2005 and 2017, 130 patients underwent pancreatectomies with type 3 or 4 (i.e., segmental resection without or with graft interposition, respectively) VR for PDAC. Patients' characteristics, surgical techniques, perioperative management, pathological findings, and outcomes were recorded and compared during 2 inclusion periods: the landmark year for the introduction of the FOLFIRINOX regimen and the hyperspecialization of our pancreatic-surgery team was 2010.Performance of pancreatectomies with VR steadily increased through the 2 inclusion periods. In the overall series (n = 130), the median overall survival time and the 5-year survival proportion were 26.3 months and 21%, respectively. Upon multivariate analysis, ASA score 3 (P = 0.01) and R1 resection margins (P < 0.01) were found to be negative independent factors influencing survival. Patients who underwent upfront VR (n = 47) had survival rates similar to those of patients who received neoadjuvant treatment (n = 83). After 2010, more complex VR were performed; however, no difference was found between the 2 periods with respect to postoperative courses, pathologic findings, or survival after a matching process based on patients' characteristics and tumor stages.Over the last 2 decades, VR during pancreatectomy has been confirmed as a safe procedure despite the increase in technical complexity. Disappointingly, we did not observe any dramatic survival improvement.
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