根治性顺行模块化胰脾切除术在胰体尾部癌中的应用(多中心研究)

目的 探讨根治性顺行模块化胰脾切除术（RAMPS）在胰体尾部癌中应用的安全性和疗效。方法 回顾性分析2010年1月至2019年12月湖南省肿瘤医院、湖南省人民医院、中南大学湘雅二医院、湘潭市中心医院和南华大学附属第二医院收治的122例胰体尾部癌RAMPS术临床资料，总结分析RAMPS手术安全性和疗效。结果 122例患者均接受RAMPS术治疗，术后并发症发生率为28.69%(35/122)，其中包括胰瘘19例（15.57%,B级14例，C级5例），单纯腹腔感染5例（4.10%），肺部感染3例（2.46%），胃排空延迟3例（2.46%），肠瘘2例（1.64%），术后出血3例（2.46%，腹腔术野出血2例，消化道出血1例）。术后26d出现严重并发症死亡2例（1.64%）。余120例患者中，1、3和5年术后复发率分别为25.00%、59.17%和85.00%，局部复发转移率、肝转移率和肺转移率分别为33.33%(40/120)、21.67%(26/120)和18.33%(22/120)。所有122例患者的1、3、5年总体生存率分别为63.51%、42.25%和22.55%。单因素Cox回归分析...

Application of radical antegrade modular pancreatosplenectomy for carcinoma of pancreatic body and tail: A multicenter study

Objective To explore the safety and efficacy of radical antegrade modular pancreatosplenectomy (RAMPS) for carcinoma of pancreatic body and tail. Methods The clinical data of 122 patients who received RAMPS in Hunan Cancer Hospital, Hunan Provincial People’s Hospital, the Second Xiangya Hospital of Central South University, Xiangtan Central Hospital, and the Second Affiliated Hospital of University of South China between Jan. 2010 and Dec. 2019 was analyzed retrospectively. Results Of 122 cases with RAMPS, the incidence rate of postoperative complications was 28.69% (35/122), including pancreatic fistula in 19 cases (15.57%, 14 cases with grade B, 5 cases with grade C), intra-abdominal infection in 5 cases (4.10%), pulmonary infection in 3 cases (2.46%), delayed gastric emptying in 3 cases (2.46%), intestinal fistula in 2 cases (1.64%), postoperative bleeding in 3 cases (2.46%, 2 cases with intraperitoneal hemorrhage, 1 case with digestive bleeding). There were 2 deaths for severe postoperative complications in 26 d (1.64%). Of the remaining 120 cases, 1-, 3- and 5-year postoperative recurrence rates were 25.00%, 59.17%, and 85.00%, respectively. The rates of local recurrence, liver and lung metastasis were 33.33% (40/120), 21.67% (26/120) and 18.33% (22/120), respectively. For all 122 patients, 1-, 3- and 5-year postoperative overall survival rates were 63.51%, 42.25% and 22.55%, respectively. Univariate analysis showed that the survival rates after RAMPS were related with tumor size, lymph node metastasis, TNM staging, perioperative blood transfusions and degree of tumor differentiation (P<0.05). Multivariate analysis showed that tumor size, lymph node metastasis and perioperative blood transfusions were independent risk factors for survival rates (P<0.05). Conclusion RAMPS is clinically proved effective, safe and feasible for carcinoma of pancreatic body and tail, which can improve the number of lymph node dissection and the rate of radical resection. Tumor size, lymph node metastasis and perioperative blood transfusions were independent risk factors for postoperative survival rate.