Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer

We report a rare case of a curative resection performed on a carcinoma developing in the remnant pancreas at 3 years 7 months after a pancreaticoduodenectomy for pancreatic cancer. A 63-year-old man underwent a pancreaticoduodenectomy for pancreatic cancer on November 1999. Because the celiac trunk was occluded by atherosclerosis, an aortohepatic bypass with a saphenous vein graft was performed simultaneously. In May 2003, tumor marker levels increased, and a tumor was detected in the remnant pancreas on computed tomography. There were no findings such as invasion into the surrounding tissue or distant metastasis, and therefore we removed the remnant pancreas in July 2003. Histopathologically, the tumor consisted of a well-differentiated tubular adenocarcinoma and was limited to the pancreas. Moreover, the anastomotic site of the pancreaticojejunostomy was negative for cancer, and some foci of papillary hyperplasia and goblet cell metaplasia of the pancreatic ductal epithelium, which was thought to be the precursor of the pancreatic cancer, were seen. These findings suggested that the tumor was a second primary cancer developing in the remnant pancreas. This case provided suggestive evidence for the development of pancreatic cancer, and the surgical procedure for a pancreaticoduodenectomy with occlusion of the celiac trunk is discussed.     

Liver metastasis with intraductal invasion originating from rectal cancer: Report of a case

We report a case of liver metastasis with intraductal invasion from colorectal cancer. The patient underwent abdominoperineal resection of the rectum for rectal cancer, and a computed tomography (CT) scan, done 4 years later, revealed a low-density lobular mass in the left lobe of the liver, with a tumor embolus in the second branch of the left bile duct (B2). Because the preoperative imaging findings showed an intraductal growth pattern, we performed a left lobectomy of the liver for intrahepatic cholangiocarcinoma (IHCC). Immunohistochemically, the carcinoma cells, including the intraductal growth, were focally positive for Cytokeratin (CK) 20, but negative for CK 7. This CK staining pattern suggested that the liver tumor was a metastasis from the previously resected rectal cancer. Thus, metastases from colorectal cancer can involve intraductal growth.     

Complete duodenum-preserving resection of the head of the pancreas with preservation of the biliary tract

A complete resection of the head of the pancreas, with preservation of the duodenum and biliary tract was performed for 14 patients: 8 with chronic pancreatitis, 3 with mucin-producing cancer of the head of the pancreas, 2 with pancreas divisum, and 1 with cystadenoma of the head of the pancreas. With our technique, duodenal blood flow is maintained, and no pancreatic parenchyma is left on the duodenal side. For these patients, a pancreaticoduodenostomy without resection of the digestive tract was provided; however, for those in whom an anastomosis between the caudal side of the pancreas and the duodenum was too difficult, due to distance, a pancreaticojejunostomy, using a Roux-en-Y jejunal loop, was performed as an alternative method. The digestive tract was reconstructed by a pancreaticoduodenostomy in 8 patients and by a pancreaticojejunostomy in the remaining 6. The operation time for the former procedure was 5h, and for the latter, 5h and 40 min; the mean blood loss in both groups was similar, being 926 and 940 ml, respectively. The successful results in all cases indicate that maintenance of the duodenal blood flow is significantly related to complete resection of the head of the pancreas. Thus, it appears that the use of Kocher's maneuver should be avoided and that the preservation of the posterior superior pancreaticoduodenal artery is important.     

Pseudomyxoma peritonei of appendiceal cancer with metastasis to the stomach: report of a case

Appendiceal cancer associated with pseudomyxoma peritonei is a relatively low-grade malignancy rarely associated with extraperitoneal metastasis. We report herein the case of a 71-year-old man in whom a metastasis was found in the stomach 2 years after he underwent surgery for pseudomyxoma peritonei of appendiceal cancer. He was referred to our hospital after presenting with anorexia and vomiting. Gastrofiberscopy, abdominal computed tomography, and ultrasound examination all revealed a mass 4 × 4 cm in size, containing a small ulcer, in the antrum of the greater curvature of the stomach. The histopathological diagnosis made from a biopsy of the tumor was mucinous cystadenocarcinoma. A distal partial gastrectomy was performed and the resected specimens from the appendiceal cancer resected 2 years earlier showed the same histological pattern as that of the gastric lesion. To the best of our knowledge, this is only the second report of pseudomyxoma peritonei secondary to mucinous cystadenocarcinoma of the appendix that metastasized to the stomach. Received: September 12, 2001 / Accepted: January 8, 2002     

Mucinous carcinoma of Vater's ampulla with a unique extension along the main pancreatic duct

We report a case of mucinous carcinoma of Vater's ampulla with a unique extension along only the main pancreatic duct (MPD) and microinvasion to the pancreas. A 52-year-old man was referred to our hospital for the evaluation and treatment of acute pancreatitis. Abdominal computed tomography (CT) demonstrated swelling in the head of the pancreas with a mass in the duodenum. Hypotonic duodenography and endoscopic examination revealed a well-defined mass, measuring about 25 mm in size, in Vater's ampulla. A biopsy specimen of the tumor showed moderately differentiated adenocarcinoma. A pylorus-preserving pancreaticoduodenectomy with a regional lymphadenectomy was performed, under a preoperative diagnosis of adenocarcinoma of Vater's ampulla with direct invasion into the head of the pancreas. The resected specimen of the duodenum confirmed the presence of the mass, which measured 22 × 15 mm in size, in Vater's ampulla. Microscopically, the tumor consisted of two components: moderately differentiated adenocarcinoma in the peripheral region of the tumor Vater's papilla and mucinous carcinoma in the central region of the tumor. The mucinous carcinoma component uniquely extended along only the MPD with microinvasion to the pancreas. Immunohistochemically, both the moderately differentiated adenocarcinoma and the mucinous carcinoma were positive for cytokeratin 20 (CK20) and negative for cytokeratin 7 (CK7) which is the pattern of intestinal-type carcinoma of Vater's ampulla. We concluded that the original site of this tumor may have been the duodenal epithelium of Vater's ampulla originally moderately differentiated adenocarcinoma—which subsequently changed to mucinous carcinoma that extended along only the MPD with microinvasion to the pancreas.     

Prospective study of the detection and treatment of small tumors of the head of the pancreas

The size of a pancreatic ductal carcinoma is one of the factors that has the greatest impact on the prognosis of the disease. Precise measurement of tumor size in such cases can obviously be achieved only by the pathologist, but, as a result of the increasingly widespread use and refinement of imaging procedures, a fairly accurate preoperative estimate now appears feasible for identifying those lesions which measure ≤2 m in size and which are conventionally defined as “small tumors.” At tomography, 15/72 patients (20.8%) with cancer of the head of the pancreas observed in our department over the period 1991 to 1994 were prospectively identified as having tumors measuring ≤2 cm. Histology subsequently confirmed that the growths measured 2 cm or less in size in only 4 of these patients, thus revealing that the imaging technique tended to underestimate the tumor diameters. If we exclude the mean time elapsing from onset of symptoms to diagnosis, which was found to be significantly shorter in small than in non-small tumors (6.3 vs 34.2 days,P <0.01), no statistically significant differences were observed in any of the clinical and blood chemistry data evaluated (including CA 19-9 values) in patients with small vs non-small tumors who underwent radical resection. Small tumors of the pancreas are still rare and their diagnosis is often incidental (2/4 in this case series) and can only be confirmed by pathology findings. The radiological detection of a small tumor, however, is strongly suggestive of resectability (more than 70% in this series). This should prompt the surgeon to adopt an aggressive approach, even though the topographical location and biological nature of tumors measuring ≤2 cm are known to be capable of substantially undermining their potentially better prognosis.     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.     

胰头区恶性肿瘤术后预后因素的研究进展

目的探讨包含壶腹部、胆管下段、胰头部、钩突部和胰颈部5个部位在内的胰头区恶性肿瘤术后的预后影响因素。方法对近年国内外有关该区域恶性肿瘤研究的文献结果进行归纳综述。结果壶腹部、胆管下段、胰头部、钩突部和胰颈部恶性肿瘤的预后与其病变部位、肿瘤直径、神经侵犯、血管侵犯、淋巴转移、病理学及组织学分型和切缘状态存在相关性。肿瘤位置及病理学分型的不同使其神经血管侵犯率、淋巴转移率和R0切除率存在差异。结论通过对肿瘤病变部位、肿瘤直径、神经侵犯、血管侵犯、淋巴转移、病理及组织学分型和切缘状态的总结分析,可提高对该区域肿瘤的临床预判准确性,有利于术前选择恰当的手术方式,术后制定更为合理的辅助治疗方案,提高人们对该区域肿瘤治疗的针对性,改善预后,以便更好地服务于临床工作。     

Rectal metastasis from Breast cancer: A rare entity

IntroductionBreast cancer metastases occurs in around 50% of all presentation. It is the second most common type of cancer to metastasise to the GI tract but this only occurs in less than 1% of cases.Presentation of caseWe report a case that underwent treatment for invasive lobular cancer (ILC) of the breast and 5 years later was found to have rectal and peritoneal metastasis. She is currently receiving palliative management including chemotherapy in the form of weekly Paclitaxel (Taxol^®) and stenting to relieve obstruction.ConclusionThere should be high clinical suspicion of bowel metastasis in patients presenting with positive faecal occult blood with or without bowel symptoms even if the incidence is less <1% of metastases, particularly in cases where the initial breast tumour was large, with positive axillary nodes.     

The outcome of patients treated with sunitinib prior to planned nephrectomy in metastatic clear cell renal cancer

Background

The role of cytoreductive nephrectomy in metastatic clear cell renal cell carcinoma (ccRCC) is controversial.

Objective

To determine the outcome of patients with metastatic ccRCC who receive sunitinib prior to planned nephrectomy.

Design, setting, and participants

The study combined the data from two prospective phase 2 studies that assessed upfront sunitinib (12-16 wk) prior to nephrectomy in previously untreated patients with metastatic renal cell carcinoma (RCC). Sunitinib was discontinued during the perioperative period (median: 29 d).

Intervention

Sunitinib 50 mg in six weekly cycles (4 wk on, 2 wk off).

Measurements

Progression-free (PFS) and overall survival (OS) using the Kaplan-Meier method.

Results and limitations

Twenty-one patients (32%) had Memorial Sloan-Kettering Cancer Centre (MSKCC) poor-risk disease; 45 (68%) had intermediate-risk disease. Nephrectomy was not performed in 19 (29%), most commonly due to disease progression (n = 12). The PFS for the cohort was 6.3 mo (95% confidence interval [CI], 5.1-8.5). Seventeen (36%) patients progressed during the treatment break, 13 (76%) of whom stabilised upon reinitiating of sunitinib. The OS for the cohort was 15.2 mo (95% CI, 10.3-NA). The OS for the intermediate MSKCC risk group was significantly longer than that for the poor-risk group (26.0 mo [95% CI, 13.6-NA] and 9.0 mo [95% CI, 5.8-20.5], respectively; p < 0.01). In multivariate analysis, progression of disease prior to planned nephrectomy (hazard ratio [HR]: 5.34; 95% CI, 3.17-13.27), high Fuhrman grade (HR 3.27; 95% CI, 1.38-7.72), and MSKCC poor risk at diagnosis (HR 4.75; 95% CI, 2.05-11.02) were associated with short survival (p < 0.01). However, in the absence of randomised studies it is not possible to determine if this approach is beneficial.

Conclusions

Upfront sunitinib prior to planned nephrectomy in intermediate-risk disease is associated with a median survival of >2 yr despite frequent progression during treatment break. Progression in metastatic sites prior to planned surgery and MSKCC poor-risk disease was associated with a poor outcome.     

扩大根治性切除治疗胰头癌

目的探讨胰腺癌扩大根治性切除术治疗胰头癌的疗效。方法采用回顾性临床对照研究,将75例实施胰十二指肠切除的胰头癌患者按手术曰期分为对照组(n=38)和研究组(n=37),比较两者的生存率、手术并发症发生率、围手术期死亡及复发率。结果对照组和研究组的手术并发症发生率分别为60.53%和29.73%;3年生存率分别为15.79%和35.14%;3年复发率分别为78.95%和35.14%。差异均有统计学意义(P0.05)。围手术期病死率分别为5.26%和2.70%(P0.05)。结论扩大根治性胰十二指肠切除术能降低胰头癌术后复发率,提高3年生存率。     

Long-term follow-up of patients with metastatic breast cancer treated by trastuzumab: Impact of institutions

PurposeTrastuzumab in Human Epidermal growth Receptor 2-positive (HER2+) metastatic breast cancer (MBC) was established as standard therapy since 2001. The objective of this study was to search for significant prognostic factors in patients with HER2+ MBC treated by trastuzumab taking into account the institution where the treatment was given.Patients & methodsAll patients with HER2+ MBC treated by trastuzumab between 2001 and 2010 in the 8 hospitals of Franche Comte region were analysed. Univariate and multivariate analysis were conducted to search for factors related to overall survival (OS).ResultsAmong 1234 patients with MBC treated by chemotherapy between 2001 and 2010, 217 patients received trastuzumab. In this subset, the median age was 60 years, 8% and 38% had brain and liver metastases at first occurrence of MBC, 36% of, tumours were hormonal receptors positive. Patients were treated in 48% and 52% of cases in specialized and in general hospitals, respectively. The median OS length was 45.2 months (IQR 23.2–89.3 months). In univariate analysis the following factors were significantly related to favourable OS: inclusion in clinical trials, treatment in a specialized hospital, positive hormonal receptors status, age <50. In multivariate analysis remained significant: treatment in specialized hospital (aHR 0.78; 95%CI 0.64–0.94; p = 0.03) and age <50 (aHR 0.76; 95%CI 0.59–0.95; p = 0.02).ConclusionExposure to trastuzumab erases all established prognostic factors at the metastatic setting. The fact that patients treated in specialized hospitals presented a longer survival emphasizes the dramatic impact of this therapy and the relevance to optimize its use.     

Pylorus-preserving pancreaticoduodenectomy with combined resection of the portal vein and gastrointestinal reconstruction by imanaga procedure for ductal cancer of the head of the pancreas

Twenty-six patients who underwent pyloruspreserving pancreaticoduodenectomy (PPPD) for ductal cancer of the head of the pancreas between 1983 and 1993 were reviewed. Gastrointestinal continuity was restored by the methods of Imanaga (n=21) and Traverso (n=5). Combined resection of the portal vein and/or superior mesenteric vein was performed in 13 patients. Surgical complications occurred in 5 patients, but there were no postoperative deaths. Delayed gastric emptying was observed in 42% of patients. The median survival time for all 26 patients was 13 months. Three patients survived for more than 3 years, and one of them is currently alive without recurrence at 10 years. Differences in survival rates were not apparent between patients who underwent PPPD with and without portal vein resection. Survival rate after PPPD was compared with that after pancreaticoduodenectomy (PD) performed between 1974 and 1992; the difference was not significant. Patients who underwent noncurative PPPD had a significantly better survival rate than those who underwent noncurative PD (P<0.05). PPPD has improved the quality of life of the resected patients, without reducing survival rate. At present, PPPD by the Imanaga procedure could be the best choice for management of cancer of the pancreatic head.     

定量RT-PCR检测结肠癌患者门静脉血CK20 mRNA的表达

目的 检测结肠癌患者门静脉血中细胞角蛋白20（CK20）mRNA的表达水平,并探讨其临床价值。方法 采用实时荧光定量RT-PCR检测31例病理学确诊的结肠癌患者门静脉血和20例健康对照者外周血CK20mRNA的表达水平。结果 结肠癌患者中CK20mRNA阳性率为25.81%,而对照组阳性率为5%,两者相比差异有统计学意义（P〈0.025）。随着临床分期的具体化,患者门静脉血中CK20mRNA表达率随之提高,但各分期间阳性率相比无显著统计学意义（P〉0.05）。DukesLC期与D期患者中〉10拷贝/ml者高于A期与B期患者。结论 术中检测结肠癌患者门静脉血CK20mRNA表达水平,对判断肝脏微转移有一定的提示意义。     

En bloc resection for locally advanced cancer of the pancreas: Is it worthwhile?

The benefit of radical surgical resection of contiguously involved structures for locally advanced pancreatic cancer is unclear. The aim of this study was to examine patient outcome after extended pancreatic resection for locally advanced tumors and to determine if any subset of extended resection affected outcome. We retrospectively reviewed the records of 116 patients with adenocarcinoma of the pancreas, who underwent extirpative pancreatic surgery between 1987 and 2000. Of the 116 patients, 37 (32%) required resection of surrounding structures (group I), and 79 patients (68%) underwent standard pancreatic resections (group II). In all cases, all macroscopic disease was excised. In group I a total of 46 contiguously involved structures were resected: vascular in 25 patients (54%), mesocolon in 16 (35%) (colic vessels in 3, colon in 13), adrenal in three (7%), liver in one (2%), stomach in one (2%) (for a tumor in the tail of the pancreas), and multiple structures in four. Excision of regional blood vessels included the superior mesenteric vein and/or portal vein in 16, hepatic artery in five, and celiac axis in four. No differences between groups I and II were detected for any of the following parameters: age, sex, history of previous operation, estimated blood loss, or hospital stay. For the entire cohort the morbidity and mortality were 38% and 1.7%, respectively, and these rates were similar in the two groups. Adjuvant therapy was administered to more than 90% of patients in both groups. However, patients in group I were more likely to have received neoadjuvant therapy (76% vs. 42%, P = 0.001). Total pancreatectomy and distal pancreatectomy were more often performed in group I (P = 0.005). Additionally, the median operative time was longer (8.5 hours compared to 6.9 hours (P = 0.0004)). Both groups had similar rates of microscopically positive margins and involved lymph nodes, as well as total number of lymph nodes removed. The median survival was 26 months for patients in group I and 16 months for patients in group II (P = 0.08). The median disease-free survival for groups I and II was 16 months and 14 months, respectively (P = 0.88). In comparing patients in group I, who underwent vascular resection vs. mesocolon (colon or middle colic vessels) resection, the median survival was 26 months and 19 months, respectively (P = 0.12). We were unable to detect a difference in outcome for patients with locally advanced cancers requiring extended pancreatic resections compared to patients with standard resections. En bloc resection of involved surrounding structures, to completely extirpate all macroscopic disease, may be of benefit in selected patients with locally advanced disease, particularly when combined with preoperative chemoradiation therapy. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23, 2002 (oral presentation).     

Chemotherapy in the treatment of cancer of the pancreas

Opinions about the value of chemotherapy in pancreatic cancer vary from the idea that its use should be abandoned because of lack of proven efficacy and considerable toxicity to the idea that it may produce clinically meaningful responses correlated with improved survival. A systematic review of the available literature-based evidence was undertaken. The results are discussed in relation to supportive evidence from recent studies focusing on patient benefit. Six randomized trials of chemotherapy in advanced disease and two in the adjuvant setting with a no-active treatment group were identified. All eight trials were small, and the methodology was not always what is currently desirable. One of four palliative trials reported during the early 1980s, and both trials completed during the 1990s showed a slight survival benefit with chemotherapy. In one of the trials, quality of life (QoL) was also more often improved after 5-fluorouracil-based chemotherapy than after best supportive care. Supportive evidence for a slight prolongation of survival and a clinical benefit also comes from trials comparing different drugs. No standard regimen is defined, although one drug, gemcitabine, has been approved in some countries for the treatment of advanced pancreatic cancer. The two randomized adjuvant trials included a very small number of patients, and, although a survival benefit was seen, conclusive evidence supporting the use of adjuvant chemo (radio) therapy is still lacking. Chemotherapy has low activity in advanced pancreatic cancer, but it can improve survival and well-being in some patients. Received for publication on June 22, 1998; accepted on July 30, 1998     

姑息性胰腺肿瘤切除的地位与作用：附107例应用分析

目的探讨中晚期胰头肿瘤手术切除方法，从而提高其切除率，同时探讨姑息性手术切除的地位及临床意义。方法回顾分析过去5年治疗107例胰腺癌患者的临床资料，观察胰腺CT对肿瘤分期判断的准确性，在血管浸润病例采取直接切断胰腺颈部方法提高手术切除率，局部应用缓释化疗粒子及局部放疗减少复发，同时观察姑息性切除患者预后的情况。结果胰腺CT对肿瘤的血管浸润判断准确性为78．5％（84／107），107例患者总的手术切除率63．55％（68／107）例，围手术期并发症发生率17．8％（19／107），死亡1例（肺部感染合并多脏器衰竭），切除患者的生存率0．5年，1年及2年分别为100％、79．4％（54／68）、41．2％（28，68）。而同期未能手术切除病例生存率分别为76．9％（30／39）、51．3％（20／39）、15．4％（6／39），两组比较统计学差异明显（P〈0．01）。结论胰腺CT扫描对于判断血管浸润具有较高准确性，直接切断胰腺颈部的方法能显著提高胰腺肿瘤的切除率，姑息性胰腺肿瘤切除配合局部放化疗能够在一定程度上延长中晚期胰腺癌患者预后，值得进一步研究观察。     

Major vascular resection as part of pancreaticoduodenectomy for cancer: Radiologic, intraoperative, and pathologic analysis

Intraoperative assessment is inaccurate in defining the relationship of a pancreatic head neoplasm to adjacent vascular structures. We evaluated the ability of preoperative contrast-enhanced CT to predict the need for vascular resection during pancreaticoduodenectomy and examined the resected vessels for histologic evidence of tumor invasion. During a 7-year period, 63 patients underwent pancreaticoduodenectomy with en bloc resection of adjacent vascular structures for a presumed pancreatic head malignancy. Clinical, radiologie, operative, and pathologic data were reviewed and analyzed. Fifty-six patients underwent resection of the superior mesenteric-portal vein confluence, three patients required inferior vena cava resection, and the hepatic artery was resected and reconstructed in eight patients. The operative mortality rate was 1.6%, and the overall complication rate was 22%. CT predicted the need for resection of the superior mesenteric or portal veins in 84% of patients. Pathologic analysis revealed tumor invasion of the vein wall in 71% of resected specimens. Tumor invasion of vascular structures adjacent to the pancreas can be predicted with preoperative CT and should alert the surgeon that vascular resection may be required. Histologic evidence of tumor cell infiltration of vessel walls was present in the majority of the resected specimens. Supported by the Various Donors Fund for Pancreatic Cancer Research at M.D. Anderson Cancer Center. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998.     

腹腔镜与开腹胰十二指肠切除术的安全性和疗效对比研究

目的 比较腹腔镜胰十二指肠切除术（LPD）和开腹胰十二指肠切除术（OPD）的安全性和疗效。方法 回顾性分析2016年1月至2021年8月期间施行胰十二指肠切除术患者的临床资料,将符合标准的49例患者分成LPD组（n=23）和OPD组（n=26）,比较两组患者的手术时间、术中出血量、术后并发症、术后住院时间、术后肿瘤学结果及预后等方面的差异。结果 LPD和OPD两种术式的术中输血率和术后胰瘘、胆瘘、术后出血、胃排空延迟、腹腔感染、并发症发生率等手术安全性指标相近（P>0.05）;LPD组较OPD组手术时间延长,但术中出血量减少（P<0.05）。两种术式术后入住ICU人数、非计划再次手术人数、标本肿瘤长径、术中淋巴结清扫数目、淋巴结阳性患者例数、R0切除率、肿瘤分化程度、术后病理分期、肿瘤来源、出院30 d内再次入院率、术后复发率、术后90 d死亡率及术后1年、2年、3年生存率等手术疗效指标相近（P>0.05）。与OPD相比,LPD术后首次下床活动时间和肛门排气时间提早,术后住院日缩短,术后疼痛评分降低和基本日常生活活动能力评分提高（P<0.05）。结论 与OPD相比,LPD安全可靠,可获得同样的肿瘤学根治效果,手术疗效值得肯定,在临床上是可行的。