Objective: To investigate the clinical efficacy of distal pancreatectomy with celiac axis resection(DP-CAR). Methods: A total of 89 consecutive patients (50 males and 39 females) who were diagnosed with pancreatic body cancer and underwent DP-CAR in Pancreas Center,First Affiliated Hospital of Nanjing Medical University between September 2013 and June 2022 were retrospectively reviewed. There were 50 males and 39 females,with age(M(IQR)) of 63(12) years(range:43 to 81 years). Perioperative parameters,pathology results and follow-up data of these patients were analyzed,χ2 or Fisher's test for categorical data while the Wilcoxon test for quantitative data. Survival results were estimated by the Kaplan-Meier survival method. Results: Among 89 cases,cases combined with portal vein-superior mesenteric vein or organ resection accounted for 22.5% (20/89) and 42.7% (38/89),respectively. The operative time,blood loss and postoperative hospital stay were 270 (110) minutes,300 (300) ml and 13 (10) days,respectively. The overall morbidity rate was 67.4% (60/89) while the major morbidity was 11.2% (10/89). The increase rate in transient liver enzymes was 42.7% (38/89),3.4% (3/89) for liver failure,53.9% (48/89) for clinically relevant postoperative pancreatic fistula,1.1% (1/89) for bile leak,3.4% (3/89) for chylous leak of grade B and C,11.2% (10/89) for abdominal infection,9.0% (8/89) for postoperative hemorrhage of grade B and C,4.5% (4/89) for delayed gastric emptying,6.7% (6/89) for deep vein thrombosis,3.4% (3/89) for reoperation,4.5% (4/89)for hospital mortality,7.9% (7/89) for 90-day mortality. The pathological type was pancreatic cancer for all 89 cases and pancreatic ductal adenocarcinoma made up 92.1% (82/89). The tumor size was 4.8(2.0) cm, ranging from 1.5 to 12.0 cm. The number of lymph nodes harvested was 14 (13)(range:2 to 33),with a positive lymph node rate of 13.0% (24.0%). The resection R0 rate was 30.0% (24/80) and the R1 (<1 mm) rate was 58.8% (47/80). The median overall survival time was 21.3 months (95%CI: 15.6 to 24.3) and the median disease-free survival time was 19.1 months (95%CI: 11.7 to 25.1). The overall survival at 1-year and 2-year were 69.60% and 39.52%. The median survival time of 58 patients with adjuvant chemotherapy was 24.3 months (95%CI: 17.8 to 32.3) while that of 13 patients without any kind of adjuvant therapy was 8.4 months (95%CI: 7.3 to 22.3). Seven patients accepted neoadjuvant chemotherapy and there was no significant morbidity among them,with a resection rate of R0 of 5/7. Conclusion: DP-CAR is safe and feasible for selective cases,which could be more valuable in improving long-term survival when combined with (neo) adjuvant therapy.
目的： 探讨联合腹腔干切除的胰体尾癌根治术（DP-CAR）治疗胰腺颈体癌的临床效果。 方法： 回顾性分析2013年9月至2022年6月南京医科大学第一附属医院胰腺中心连续收治的89例因胰腺颈体癌行DP-CAR治疗的患者资料。男性50例，女性39例；年龄［M（IQR）］63（12）岁（范围：43~81岁）。分类资料采用χ2检验或Fisher确切概率法分析，定量资料以秩和检验分析，以Kaplan-Meier法绘制生存曲线并估计中位生存时间。 结果： 89例DP-CAR中，联合门静脉-肠系膜上静脉切除重建20例（22.5%）、联合器官切除38例（42.7%）；手术时间270（110）min（范围：143~530 min），术中出血量300（300）ml（范围：50~2 500 ml），术后住院时间13（10）d（范围：7~101 d）。总体并发症发生率为67.4%（60/89），其中Clavien-Dindo并发症分级系统≥Ⅲ级10例（11.2%），术后出现一过性肝脏转氨酶升高38例（42.7%）、肝功能衰竭3例（3.4%）、B级和C级胰瘘48例（53.9%）、胆瘘1例（1.1%）、B级和C级乳糜瘘3例（3.4%）、腹腔感染10例（11.2%）、B级和C级术后出血8例（9.0%）、胃排空延迟4例（4.5%）、深静脉血栓形成6例（6.7%），再手术3例（3.4%）。住院期间死亡4例（4.5%），术后90 d内死亡7例（7.9%）。89例均为胰腺癌，其中胰腺导管腺癌占92.1%（82/89）；肿瘤最大径4.8（2.0）cm（范围：1.5~12.0 cm），共清扫淋巴结14（13）枚（范围：2~33枚），淋巴结阳性率为13.0%（24.0%）；R0切除率为30.0%（24/80）、R1（<1 mm）切除率为58.8%（47/80）；术后中位生存时间为21.3个月（95%CI：15.6~24.3个月），中位无病生存时间为19.1个月（95%CI：11.7~25.1个月），术后1年总体生存率为69.60%，术后2年总体生存率为39.52%。58例术后行辅助化疗者的中位生存时间为24.3个月（95%CI：17.8~32.3个月），13例术后未行化疗或其他辅助治疗者的中位生存时间为8.4个月（95%CI：7.3~22.3个月）；7例患者于术前行新辅助化疗，无Clavien-Dindo并发症分级系统Ⅲ级以上并发症发生，R0切除率为5/7。 结论： 对选择性的胰腺颈体癌病例，联合腹腔干切除的胰体尾癌根治术是可行的，（新）辅助治疗可能可以改善患者的术后生存。.