原发灶联合胰腺及其周围脏器切除术治疗27例局部进展期结肠癌的临床资料分析

Clinical analysis of resecting primary tumors along with pancreas and adjacent or⁃gans in 27 patients with locally advanced colon cancer

目的探讨原发灶联合胰腺及其周围脏器切除术治疗27例局部进展期结肠癌的临床疗效。方法回顾性分析2018年4月至2022年12月中国人民解放军联勤保障部队第九〇〇医院收治的27例因原发结肠癌侵犯胰腺及其周围脏器而行原发灶联合胰腺及其周围脏器切除术患者的临床资料。收集并分析脏器受累情况、手术情况、术后病理、术后并发症、随访与生存情况等临床资料。结果27例进展期结肠癌中,共累及胰腺及其周围脏器58例次,其中累及胰腺占46.6%,脾脏占22.4%,十二指肠占13.8%,胃占3.4%,空肠占3.4%,肝脏占5.2%,肾脏占3.4%,胆囊占1.7%。实施具体术式包括右半结肠联合胰腺切除术(右半结肠+保留幽门的胰十二指肠切除术3例、右半结肠+胰十二指肠+右肝部分切除术3例、右半结肠+胰十二指肠切除术2例)、横结肠联合胰腺切除术(横结肠+胰体尾+脾脏+部分胃切除术2例、横结肠+胰体尾+脾脏+空肠部分切除术2例)、左半结肠联合胰腺切除术(左半结肠+胰体尾+脾脏切除)11例、左半结肠+保留脾脏的胰体尾+左肾切除2例、左半结肠+保留脾脏的胰体尾切除术2例)。平均术中出血量(375.9±103.1)m L,平均手术时间(3.6±0.8)h。R0切除26例,R1切除1例;累及周围脏器病理类型属于癌性浸润24例、炎性浸润3例;溃疡型中分化腺癌12例、溃疡型中低分化腺癌5例,浸润型中低分化腺癌8例,巨块息肉型中分化腺癌2例;pT_(4b)N_(1)M_(0)11例,pT_(4b)N_(2)M0_(1)3例,pT_(4a)N_(1)M_(0)3例。无手术相关死亡病例。术后住院时间10~35 d,平均(16.8±5.0)d。11例出现术后并发症,包括胰漏6例,感染3例,吻合口漏1例,术后出血1例。均经加强抗炎、引流等保守治疗后痊愈。随访截至2023年4月,中位随访时间20.5(4~49)个月,27例患者中存活20例,死亡7例。随访过程中,2例出现肿瘤复发,2例肝转移,1例肺转移,均行全身系统治疗。结论局部进展期结肠癌侵犯胰腺、十二指肠等相关脏器,伴有急症或经评估可实现R0切除,且在患者可耐受的情况下,应积极考虑联合胰腺及其周围脏器切除。

Objectives This study aimed to evaluate the clinical efficacy of resecting primary tumors along with pancreas and adjacent organs in the treatment of locally advanced colon cancer.Methods We retrospectively examined the medical records of 27 patients treated at the 900th Hospital of The Joint Logistics Support Force of the Chinese PLA between April 2018 and De⁃cember 2022.These patients underwent surgery to remove the primary tumors,pancreas,and adjacent organs due to the invasion of the primary colon cancer into the pancreas and adjacent organs.We analyzed various clinical factors,including the organs in⁃volved,surgical procedures,postoperative pathology,postoperative complications,follow-up,and survival.Results In the cohort of locally advanced colon cancer patients,58 organs were involved.The pancreas was involved in 46.6%of instances,followed by the spleen(22.4%),duodenum(13.8%),stomach(3.4%),jejunum(3.4%),liver(5.2%),kidneys(3.4%),and gallbladder(1.7%).Sur⁃gical procedures included:(1)right hemicolon with pancreatectomy(3 cases underwent right hemicolon with pylorus-preserving pancreaticoduodenectomy,3 with pancreaticoduodenum and right liver partial resection,and 2 with pancreaticoduodenectomy);(2)Transverse colon combined with pancreatectomy(2 cases involved pancreatic body,tail,spleen,and partial gastrectomy,while 2 involved pancreatic body,tail,spleen,and partial jejunum resection);(3)Left hemicolon with pancreatectomy(11 cases underwent left hemicolon with pancreatic body and tail splenectomy,2 with spleen-preserving pancreatic body and tail and left nephrecto⁃my,and 2 with spleen-preserving pancreatic body and tail resection).The average intraoperative bleeding was(375.9±103.1)mL,and the average surgical duration was(3.6±0.8)hours.Among the 27 cases,26 had R0 resection and one had R1.Pathological examination revealed cancerous infiltration in 24 cases and inflammatory infiltration in 3 cases.Tumor histology comprised 12 moderate adenocarcinomas(ulcerative type),5 moderately-poor adenocarcinomas(ulcerative),8 moderately-poor adenocarcinomas(infiltrative),and 2 moderate adenocarcinomas(massive polyp).Tumor stages were 11 pT_(4b)N_(1)M_(0),13 pT_(4b)N_(2)M_(0),and 3 pT_(4a)N_(1)M_(0).There were no postoperative deaths.The median postoperative hospital stay was(16.8±5.0)days(range:10-35 days).Postopera⁃tive complications occurred in 11 cases,including 6 cases of pancreatic leakage,3 infections,1 anastomotic leakage,and 1 post⁃operative bleeding.All patients recovered with conservative treatment such as enhanced anti-inflammatory therapy and drainage.The median follow-up time was 20.5 months(range:4-49).Among the 27 patients,20 survived and 7 died.During the followup,2 experienced recurrence,2 had liver metastasis,and 1 had lung metastasis,all of which received systemic treatment.Conclusion For locally advanced colon cancer invading organs such as the pancreas or duodenum,it’s advisable to consider com⁃bined pancreas and adjacent organs resections,either as an emergency or to aim for R0 resection,provided the patient can en⁃dure the procedure.