1 材料和方法1982-10/2000-02我院收治急性重症胰腺炎86例,手术治疗61例(72%),非手术治疗25例(29%),发生各种并发症65例(75%),死亡19例(病死率为21%),其中胰性脑病13例(发生率为15%),死于胰性脑病6例(46%).男6例,女7例,年龄31岁～82岁(...1 材料和方法1982-10/2000-02我院收治急性重症胰腺炎86例,手术治疗61例(72%),非手术治疗25例(29%),发生各种并发症65例(75%),死亡19例(病死率为21%),其中胰性脑病13例(发生率为15%),死于胰性脑病6例(46%).男6例,女7例,年龄31岁～82岁(平均47.4岁).本组13例胰性脑病中10例施行手求治疗,3例未手术.13例胰性脑病死亡6例,病死率为46%.本组胰性脑病从急性重症胰腺炎起病至病后57 d 均有发生,手术前后均有胰性脑病发生,胰性脑病多在术后36展开更多
Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgica...Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgical therapy in this disease.This study aimed to investigate the impact of extent of pancreatic and venous resection on short-and long-term outcomes in patients with pancreatic adenocarcinoma(PDAC).Methods:This was a retrospective study from a prospectively maintained database of pancreatic resections for PDAC.Short-and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy(TP)or pancreaticoduodenectomy(PD)with simultaneous portal vein(PV)and/or superior mesenteric vein(SMV)resection.Venous resections were carried out as tangential venous resection(TVR)or segmental venous resection(SVR).Patients were divided into 4 groups:(1)PD+TVR,(2)PD+SVR,(3)TP+TVR,(4)TP+SVR.Uni-and multivariate Cox regression analysis were performed to identify factors associated with survival.Results:Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for PDAC.Among them,25 were submitted to PD+TVR(25.3%),12 to PD+SVR(12.1%),23 to TP+TVR(23.2%),and 39 to TP+SVR(39.4%).Overall,major morbidity(Clavien-Dindo grade≥IIIA)was 26.3%.Thirty-and 90-day mortality were 3%and 11.1%,respectively.There were no significant differences among groups in terms of short-term outcomes.Median overall survival of patients submitted to PD+TVR was significantly higher than those to TP+SVR(29.5 vs 7.9 months,P=0.001).Multivariate analysis identified TP(HR=2.11;95%CI:1.31–3.44;P=0.002)and SVR(HR=2.01;95%CI:1.27–3.15;P=0.003)as the only independent prognostic factors for overall survival.Conclusions:Up-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC.Perioperative treatments in high-risk surgical groups may improve such poor outcomes.展开更多
文摘1 材料和方法1982-10/2000-02我院收治急性重症胰腺炎86例,手术治疗61例(72%),非手术治疗25例(29%),发生各种并发症65例(75%),死亡19例(病死率为21%),其中胰性脑病13例(发生率为15%),死于胰性脑病6例(46%).男6例,女7例,年龄31岁～82岁(平均47.4岁).本组13例胰性脑病中10例施行手求治疗,3例未手术.13例胰性脑病死亡6例,病死率为46%.本组胰性脑病从急性重症胰腺炎起病至病后57 d 均有发生,手术前后均有胰性脑病发生,胰性脑病多在术后36
文摘Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgical therapy in this disease.This study aimed to investigate the impact of extent of pancreatic and venous resection on short-and long-term outcomes in patients with pancreatic adenocarcinoma(PDAC).Methods:This was a retrospective study from a prospectively maintained database of pancreatic resections for PDAC.Short-and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy(TP)or pancreaticoduodenectomy(PD)with simultaneous portal vein(PV)and/or superior mesenteric vein(SMV)resection.Venous resections were carried out as tangential venous resection(TVR)or segmental venous resection(SVR).Patients were divided into 4 groups:(1)PD+TVR,(2)PD+SVR,(3)TP+TVR,(4)TP+SVR.Uni-and multivariate Cox regression analysis were performed to identify factors associated with survival.Results:Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for PDAC.Among them,25 were submitted to PD+TVR(25.3%),12 to PD+SVR(12.1%),23 to TP+TVR(23.2%),and 39 to TP+SVR(39.4%).Overall,major morbidity(Clavien-Dindo grade≥IIIA)was 26.3%.Thirty-and 90-day mortality were 3%and 11.1%,respectively.There were no significant differences among groups in terms of short-term outcomes.Median overall survival of patients submitted to PD+TVR was significantly higher than those to TP+SVR(29.5 vs 7.9 months,P=0.001).Multivariate analysis identified TP(HR=2.11;95%CI:1.31–3.44;P=0.002)and SVR(HR=2.01;95%CI:1.27–3.15;P=0.003)as the only independent prognostic factors for overall survival.Conclusions:Up-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC.Perioperative treatments in high-risk surgical groups may improve such poor outcomes.
