用胰腺切除术克服静脉切除的技术挑战:哪些因素决定了生存?
Elena B Rangelova1, Poya Ghorbani2, Roberto Valente3
1Department of Surgery, Section for Upper Abdominal Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
概括
带有静脉切除的胰腺切除术 (PVR) 是一种标准的手术. 患者和瘤因素,而不是手术技术,预测胰腺癌PVR后的长期存活率.
科学领域:
- 手术瘤学手术瘤学
- 胃肠道手术 胃肠道手术
- 血管重建 血管重建
背景情况:
- 带有静脉切除的胰腺切除术 (PVR) 是一种标准的瘤手术.
- 有关术后发病率和与静脉切除和重建技术相关的长期结果存在担忧.
研究的目的:
- 在接受PVR的患者中确定发病率和长期存活的预测因素.
- 评估不同静脉切除和重建策略对患者结果的影响.
主要方法:
- 对从2008年1月到2019年1月连续接受PVR患者的前性维护数据库的分析.
- 多变量分析以确定与术后并发症和长期存活相关的因素.
主要成果:
- 在290名患者中,188名 (65%) 患有胰腺管道腺癌 (PDAC). 56%的人出现并发症,其中11%是严重的 (Clavien-Dindo>3a). 90天的死亡率为4.1%.
- 没有任何技术因素预测严重的并发症. 较长的静脉段 (>3厘米) 有类似的结果. 对于PDAC,在切除能力阶段的生存率相似.
- 升高的CA19-9 (>200 U/mL) 和ASA得分 (≥3) 是生存的独立预测因素,而不是切除能力或静脉重建类型.
结论:
- 静脉切除和重建应根据患者和瘤的特征进行,因为该技术本身不会影响结果.
- 对于PDAC的PVR后的长期存活主要是由患者和瘤因素驱动的,而不是血管切除的技术方面.
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