胰腺癌新辅助化疗后腹腔镜手术治疗的效果分析

Effect of laparoscopic surgery for pancreatic cancer after neoadjuvant chemotherapy

目的探讨胰腺癌接受新辅助化疗后行腹腔镜手术治疗的临床效果。方法回顾性分析2019年9月至2020年6月在复旦大学附属肿瘤医院胰腺外科接受腹腔镜手术治疗的8例新辅助化疗后胰腺癌患者的临床资料。其中男性5例,女性3例;年龄47~72岁。所有患者术前均行腹部增强CT检查和PET-CT检查,以准确评估肿瘤分期,并排除远处转移。结果8例患者术前均接受AG方案(吉西他滨1000 mg/m2+白蛋白结合型紫杉醇125 mg/m2,第1、8、15天,每4周1个周期)新辅助化疗2~6周期,并顺利完成手术。其中接受胰十二指肠切除术5例,根治性顺行模块化胰脾切除术2例,全胰腺切除术1例,无中转开腹或腹腔镜辅助手术。手术时间240~450 min,术中出血量100~500 ml,术后住院时间10~16 d。随访截至2020年12月31日,术后发生并发症1例(B级胰瘘伴腹腔感染),无围手术期死亡。淋巴结清扫数目为9~31枚。所有患者均获得R0切除。随访时间4.5~9.5个月,其中1例胰体尾癌患者术后2个月发生肝转移,其余7例患者仍无瘤存活。结论在经验丰富的胰腺微创外科中心,胰腺癌患者新辅助化疗后接受腹腔镜手术治疗具有较好的临床效果。

Objective To evaluate the safety and feasibility of laparoscopic surgery after neoadjuvant chemotherapy for pancreatic cancer.Methods Clinical data of 8 patients underwent laparoscopic surgery after neoadjuvant chemotherapy for pancreatic cancer at Fudan University Shanghai Cancer Center from September 2019 to June 2020 were reviewed retrospectively.There were 5 males and 3 females,aged from 47 to 72 years old.All patients underwent abdominal enhanced CT and PET-CT before operation to accurately evaluate the tumor stage and exclude distant metastasis.Results Neoadjuvant chemotherapy with AG regimen(gemcitabine 1000 mg/m2 and albumin bound paclitaxel 125 mg/m2)was received for 2 to 6 cycles before surgery.All 8 patients successfully completed the operation,including 5 cases of pancreaticoduodenectomy,2 cases of radical antegrade modular pancreatosplenectomy(RAMPS),and 1 case of total pancreatectomy.No conversion to laparotomy or laparoscopic assisted surgery.The operation time was 240 to 450 minutes,the blood loss was 100 to 500 ml,the postoperative length of stay was 10 to 16 days.During the follow-up period up to December 31,2020,there was 1 case suffered grade B pancreatic leakage and abdominal infection.The numbers of resected lymph nodes were 9 to 31.All patients received R0 resection.The follow-up times were 4.5 to 9.5 months.One patient underwent RAMPS was diagnosed as liver metastasis after 2 months of the operation,and the other 7 patients still survived without tumor recurrence.Conclusion Minimally invasive surgery of pancreatic cancer after neoadjuvant chemotherapy is safe and feasible in experienced pancreatic minimally invasive centers.