双原发胰腺癌13例临床分析

Surgical outcome of a resectable primary cancer of pancreas associated with another synchronous/meta- chronoas resectable primary malignant tumor： a report of 13 patients and review of the literature

目的分析累及胰腺的双原发恶性肿瘤的临床特点，提高对本病的认识及诊治水平。方法对2000至2012年10月间收治的经病理证实的13例双原发胰腺癌的临床特点、手术结果以及预后等进行回顾性分析。结果13例患者中，男性4例，女性9例，平均年龄70岁。其中，11例为异时性双原发胰腺癌，2例为同时性双原发胰腺癌。全部行根治性手术治疗。结论通过分析研究，提高对双原发胰腺癌的认识，及时正确地做出诊断和治疗有重要意义。双原发胰腺癌的预后主要与胰腺癌本身相关，与其他器官的原发恶性肿瘤关系较小，行手术根治性治疗可以取得较好的效果。

Objective The incidence of a resectable primary cancer of pancreas associated with another synchronous/metachronous resectable primary malignant tumor is low. The aim of this study was to investigate the clinical features and to review our experience and outcomes with surgical treat- ment for these patients. Methods Between January 2000 and October 2012, 13 patients （nine females and four males, median age.. 70 years, range： 56-79 years） were admitted into our hospital with a re- sectable primary cancer of pancreas which was associated with another synchronous/metachronous re- sectable primary malignant tumor. The clinical features, treatment and results were analysed. Results The other primary tumors were non-small-cell lung carcinoma （n= 2）, gastric carcinoma （n= 2）, lob- ular carcinoma of breast （n= 3）, colonic carcinoma （n = 2）, esophageal carcinoma （n = 1）, renal cell carcinoma （n= 1）, malignant thymoma （n= 1）, and endometrial carcinoma （n= 1）. Among these pa- tients, eleven were metachronous pancreatic cancer which occurred after resection of the other organ malignancies. Two patients were synchronous pancreatic cancer. All patients underwent radical opera- tion that included eleven pancreaticoduodenectomy and two distal pancreatectomies with splenectomy. There were no patients who died in the peri-operative period, but three patients developed a pancreatic fistula. The morbidity rate was 20 ~. The median survival of the radically operated patients was I5 months （range; 4-35 months）. Nine patients died of disease, while 4 are still alive at the time of this report. Conclusions Surgical resection could be performed safely in selected patients with a resectable primary carcinoma of pancreas which was associated with another synchronous/metachronous resect- able malignant tumor with good long-term survival outcomes. The final survival would depend on the primary cancer of pancreas.