Abstract：
BACKGROUND: The appropriate surgical approach for pancreatic ductal adenocarcinoma (PDAC) is determined by the tumor\'s relation to the porto-mesenteric axis. Although the extent and location of lymphadenectomy is dependent on the type of resection, a pancreatoduodenectomy (PD), distal pancreatectomy (DP), or total pancreatectomy (TP) are considered equivalent oncologic operations for pancreatic neck tumors. Therefore, we aimed to assess differences in histopathological and oncological outcomes for surgical approaches in the treatment of pancreatic neck tumors.
METHODS: Patients with resected PDAC located in the pancreatic neck were identified from the National Cancer Database (2004-2020). Patients with metastatic disease were excluded. Furthermore, patients with 90-day mortality and R2-resections were excluded from the multivariable Cox-regression analysis.
RESULTS: Among 846 patients, 58% underwent PD, 25% DP, and 17% TP with similar R0-resection rates (p = 0.722). Significant differences were observed in nodal positivity (PD:44%, DP:34%, TP:57%, p < 0.001) and mean-number of examined lymph nodes (PD:17.2 ± 10.4, DP:14.7 ± 10.5, TP:21.2 ± 11.0, p < 0.001). Furthermore, inadequate lymphadenectomy (< 12 nodes) was observed in 30%, 44%, and 19% of patients undergoing PD, DP, and TP, respectively (p < 0.001). Multivariable analysis yielded similar overall survival after DP (HR:0.83, 95%CI:0.63-1.11), while TP was associated with worse survival (HR:1.43, 95%CI:1.08-1.89) compared to PD.
CONCLUSIONS: While R0-rates are similar amongst all approaches, DP is associated with inadequate lymphadenectomy which may result in understaging disease. However, this had no negative influence on survival. In the premise that an oncological resection of the pancreatic neck tumor is feasible with a partial pancreatectomy, no benefit is observed by performing a TP.
METHODS: Patients with resected PDAC located in the pancreatic neck were identified from the National Cancer Database (2004-2020). Patients with metastatic disease were excluded. Furthermore, patients with 90-day mortality and R2-resections were excluded from the multivariable Cox-regression analysis.
RESULTS: Among 846 patients, 58% underwent PD, 25% DP, and 17% TP with similar R0-resection rates (p = 0.722). Significant differences were observed in nodal positivity (PD:44%, DP:34%, TP:57%, p < 0.001) and mean-number of examined lymph nodes (PD:17.2 ± 10.4, DP:14.7 ± 10.5, TP:21.2 ± 11.0, p < 0.001). Furthermore, inadequate lymphadenectomy (< 12 nodes) was observed in 30%, 44%, and 19% of patients undergoing PD, DP, and TP, respectively (p < 0.001). Multivariable analysis yielded similar overall survival after DP (HR:0.83, 95%CI:0.63-1.11), while TP was associated with worse survival (HR:1.43, 95%CI:1.08-1.89) compared to PD.
CONCLUSIONS: While R0-rates are similar amongst all approaches, DP is associated with inadequate lymphadenectomy which may result in understaging disease. However, this had no negative influence on survival. In the premise that an oncological resection of the pancreatic neck tumor is feasible with a partial pancreatectomy, no benefit is observed by performing a TP.
摘要：
背景：胰腺导管腺癌（PDAC）的适当手术方法取决于肿瘤与肠系膜轴的关系。尽管淋巴结清扫术的范围和位置取决于切除的类型，胰十二指肠切除术(PD),远端胰腺切除术(DP),或全胰腺切除术（TP）被认为是胰腺颈部肿瘤的等效肿瘤学手术。因此,我们旨在评估胰腺颈部肿瘤手术治疗在组织病理学和肿瘤学结局方面的差异.
方法：从国家癌症数据库（2004-2020）确定胰腺颈部切除PDAC的患者。转移性疾病患者被排除在外。此外，多变量Cox回归分析中排除了90天死亡率和R2切除的患者.
结果：在846名患者中，58%接受了PD,25%DP,和17%TP，R0切除率相似（p=0.722）。在淋巴结阳性方面观察到显著差异(PD：44%，DP:34%,TP:57%,p<0.001）和检查的淋巴结平均数（PD：17.2±10.4，DP：14.7±10.5，TP：21.2±11.0，p<0.001）。此外，淋巴结清扫不充分（<12个淋巴结）观察到30％，44%,19%的病人接受PD,DP,TP,分别(p<0.001)。多变量分析得出的DP后总生存期相似（HR：0.83，95CI：0.63-1.11），与PD相比，TP与较差的生存率（HR：1.43，95CI：1.08-1.89）相关。
结论：虽然R0-rates在所有方法中相似，DP与不充分的淋巴结清扫术有关，这可能导致疾病分期不足。然而,这对生存没有负面影响。在胰腺部分切除术的前提下，胰腺颈部肿瘤切除术是可行的，通过进行TP没有观察到益处。
方法：从国家癌症数据库（2004-2020）确定胰腺颈部切除PDAC的患者。转移性疾病患者被排除在外。此外，多变量Cox回归分析中排除了90天死亡率和R2切除的患者.
结果：在846名患者中，58%接受了PD,25%DP,和17%TP，R0切除率相似（p=0.722）。在淋巴结阳性方面观察到显著差异(PD：44%，DP:34%,TP:57%,p<0.001）和检查的淋巴结平均数（PD：17.2±10.4，DP：14.7±10.5，TP：21.2±11.0，p<0.001）。此外，淋巴结清扫不充分（<12个淋巴结）观察到30％，44%,19%的病人接受PD,DP,TP,分别(p<0.001)。多变量分析得出的DP后总生存期相似（HR：0.83，95CI：0.63-1.11），与PD相比，TP与较差的生存率（HR：1.43，95CI：1.08-1.89）相关。
结论：虽然R0-rates在所有方法中相似，DP与不充分的淋巴结清扫术有关，这可能导致疾病分期不足。然而,这对生存没有负面影响。在胰腺部分切除术的前提下，胰腺颈部肿瘤切除术是可行的，通过进行TP没有观察到益处。
