Int J Surg. 2023 May 17. doi: 10.1097/JS9.0000000000000437. Online ahead of print.
ABSTRACT
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor with relatively poor survival. Surgery is the first choice for treating patients with early pancreatic cancer. However, the surgical approach and the extent of resection for patients with pancreatic cancer are currently controversial.
METHODS: We optimized the procedure of standard pancreaticoduodenectomy to selective extended dissection (SED), which is based on the extra-pancreatic nerve plexus (PLX) potentially invaded by the tumor. We retrospectively analyzed the clinicopathological data of patients with pancreatic adenocarcinoma who underwent radical surgery in our center from 2011 to 2020. Patients who underwent standard dissection (SD) were matched 2:1 to those who underwent SED using propensity score matching (PSM). The log-rank test and cox regression model were used to analyze survival data. In addition, statistical analyses were performed for the perioperative complications, postoperative pathology and recurrence pattern.
RESULTS: A total of 520 patients were included in the analysis. Among patients with extra-pancreatic perineural invasion (EPNI), disease-free survival (DFS) was significantly longer in those who received SED than in those who received SD (14.5 mo vs. 10 mo, P<0.05). The incidence of metastasis in No.9 and No.14 lymph nodes was significantly higher in patients with EPNI. In addition, there was no significant difference in the incidence rate of perioperative complications between the two surgical procedures.
CONCLUSION: Compared with SD, SED exhibits significant prognostic benefit for patients with EPNI. The SED procedure aiming at specific nerve plexus dissection displayed particular efficacy and safety in resectable PDAC patients.
PMID:37195787 | DOI:10.1097/JS9.0000000000000437
