交界可切除胰头癌新辅助化疗后行联合静脉切除重建 LPD 的初步体会_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

徐均 ^1,2 , 孟令威 ^1,2 , 蔡云强 ^1,2 , 李永彬 ^1,2 ,  彭兵 ^1,2

1. ;
2. ;

Corresponding author：

彭兵, Email: pengbing84@hotmail.com

Keywords：

交界可切除胰腺癌; 腹腔镜胰十二指肠切除术; 新辅助化疗; 血管切除重建

DOI：

10.7507/1007-9424.202107093

Video：

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目的探讨交界可切除胰头癌新辅助化疗后行联合静脉切除重建的腹腔镜胰十二指肠切除术（laparoscopic pancreaticoduodenectomy，LPD）的安全性及可行性。方法回顾性收集并分析 2019 年 8 月至 2021 年 1 月期间于四川大学华西医院上锦分院肝胆胰微创外科实施的 4 例交界可切除胰头癌新辅助化疗后行联合血管切除重建的 LPD 患者的临床资料。结果 4 例患者均在完全腹腔镜下完成手术，手术时间分别为 520、452、375 和 430 min，术中出血量分别为 300、800、150 和 200 mL，术后住院时间分别为 36、20、16 和 16 d。术后 1 例患者出现胆汁漏、行再次引流后好转出院，1 例出现乳糜漏，导致引流管拔除时间及住院时间延长，其余 2 例未出现并发症，正常出院。4 例患者术后病理学检查证实均为胰头导管腺癌，总生存期分别为 18、12、20 和 11 个月（仍存活）。结论对于高度选择性的交界可切除胰头癌新辅助化疗后行联合静脉切除重建的 LPD 在经验丰富的大的胰腺中心是安全可行的，但仍需大样本随机对照试验来验证这一结论。

Citation： 徐均, 孟令威, 蔡云强, 李永彬, 彭兵. 交界可切除胰头癌新辅助化疗后行联合静脉切除重建 LPD 的初步体会. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(9): 1144-1147. doi: 10.7507/1007-9424.202107093 Copy

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14.	Luo G, Liu C, Guo M, et al. Potential biomarkers in lewis negative patients with pancreatic cancer. Ann Surg, 2017, 265(4): 800-805.
15.	Napolitano F, Formisano L, Giardino A, et al. Neoadjuvant treatment in locally advanced pancreatic cancer (lapc) patients with FOLFIRINOX or gemcitabine nabpaclitaxel: A single-center experience and a literature review. Cancers (Basel), 2019, 11(7): 981.
16.	梁廷波, 白雪莉, 李想. 胰腺癌新辅助治疗的进展及面临的问题. 中国普外基础与临床杂志, 2017, 24(6): 657-660.
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18.	Belyaev O, Munding J, Herzog T, et al. Histomorphological features of the pancreatic remnant as independent risk factors for postoperative pancreatic fistula: a matched-pairs analysis. Pancreatology, 2011, 11(5): 516-524.
19.	de Rooij T, Lu MZ, Steen MW, et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg, 2016, 264(2): 257-267.
20.	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
21.	Ravikumar R, Sabin C, Abu Hilal M, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Br J Surg, 2017, 104(11): 1539-1548.
22.	Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg, 2015, 19(1): 189-194.
23.	Zhiying Y, Haidong T, Xiaolei L, et al. The falciform ligament as a graft for portal-superior mesenteric vein reconstruction in pancreatectomy. J Surg Res, 2017, 218: 226-231.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
2. Viale PH. The American Cancer Society’s facts & figures: 2020 edition. J Adv Pract Oncol, 2020, 11(2): 135-136.
3. Michelakos T, Pergolini I, Castillo CF, et al. Predictors of resectability and survival in patients with borderline and locally advanced pancreatic cancer who underwent neoadjuvant treatment with FOLFIRINOX. Ann Surg, 2019, 269(4): 733-740.
4. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2. 2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
5. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009, 45(2): 228-247.
6. 李永彬, 蔡云强, 王昕, 等. 流程优化的全腹腔镜胰十二指肠切除术的临床总结(附手术视频). 四川大学学报(医学版), 2020, 51(4): 446-452.
7. Cai Y, Gao P, Li Y, et al. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc, 2018, 32(10): 4209-4215.
8. Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the dutch randomized phase Ⅲ PREOPANC trial. J Clin Oncol, 2020, 38(16): 1763-1773.
9. Jang JY, Han Y, Lee H, et al. Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: A prospective, randomized, open-label, multicenter phase 2/3 trial. Ann Surg, 2018, 268(2): 215-222.
10. 中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南(2021). 中国实用外科杂志, 2021, 41(7): 721-734.
11. Dhir M, Zenati MS, Hamad A, et al. FOLFIRINOX versus gemcitabine/nab-paclitaxel for neoadjuvant treatment of resectable and borderline resectable pancreatic head adenocarcinoma. Ann Surg Oncol, 2018, 25(7): 1896-1903.
12. Heger U, Sun H, Hinz U, et al. Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival. HPB (Oxford), 2020, 22(2): 224-232.
13. Cassinotto C, Sa-Cunha A, Trillaud H. Radiological evaluation of response to neoadjuvant treatment in pancreatic cancer. Diagn Interv Imaging, 2016, 97(12): 1225-1232.
14. Luo G, Liu C, Guo M, et al. Potential biomarkers in lewis negative patients with pancreatic cancer. Ann Surg, 2017, 265(4): 800-805.
15. Napolitano F, Formisano L, Giardino A, et al. Neoadjuvant treatment in locally advanced pancreatic cancer (lapc) patients with FOLFIRINOX or gemcitabine nabpaclitaxel: A single-center experience and a literature review. Cancers (Basel), 2019, 11(7): 981.
16. 梁廷波, 白雪莉, 李想. 胰腺癌新辅助治疗的进展及面临的问题. 中国普外基础与临床杂志, 2017, 24(6): 657-660.
17. 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会. 中国胰腺癌新辅助治疗指南(2020 版). 协和医学杂志, 2020, 11(5): 547-558.
18. Belyaev O, Munding J, Herzog T, et al. Histomorphological features of the pancreatic remnant as independent risk factors for postoperative pancreatic fistula: a matched-pairs analysis. Pancreatology, 2011, 11(5): 516-524.
19. de Rooij T, Lu MZ, Steen MW, et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg, 2016, 264(2): 257-267.
20. Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
21. Ravikumar R, Sabin C, Abu Hilal M, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Br J Surg, 2017, 104(11): 1539-1548.
22. Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg, 2015, 19(1): 189-194.
23. Zhiying Y, Haidong T, Xiaolei L, et al. The falciform ligament as a graft for portal-superior mesenteric vein reconstruction in pancreatectomy. J Surg Res, 2017, 218: 226-231.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

交界可切除胰头癌新辅助化疗后行联合静脉切除重建 LPD 的初步体会

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