Total pancreatectomy plus splenectomy in treatment for pancreatic cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Yayun ^1,2 , WANG Haijiu ^1,3 , ZHANG Lingqiang ^1,3 , WANG Zhixin ^1,3 , Yangdancairang ^1,3 , REN Li ^1,3 , ZHOU Ying ^1,3 , FAN Haining ^1,3 ,  HOU Lizhao ^1,3

1. Department of Hepatopancreaticobiliary Surgery, Affiliated Hospital of Qinghai University, Xining 810001, P. R. China;
2. Medical College of Qinghai University, Xining 810001, P. R. China;
3. Qinghai Province Key Laboratory of Hydatid Disease Research, Xining 810001, P. R. China;

Corresponding?author：

HOU Lizhao, Email: zhuoyue1973@163.com

Keywords：

pancreatic cancer; total pancreatectomy; splenectomy

DOI：

10.7507/1007-9424.201806076

Video：

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Objective To investigate safety and therapeutic effect of total pancreatectomy plus splenectomy for patient with pancreatic cancer. Methods The preoperative clinical data, surgical treatment, and postoperative conditions of 1 patient with pancreatic cancer who underwent the total pancreatectomy plus splenectomy in the Affiliated Hospital of Qinghai University in January 2018 were retrospectively analyzed. Results Combination of the patient clinical history, physical examination, laboratory and radiologic results, the patient was diagnosed with the pancreatic cancer. Then the patient underwent the Whipple procedure. During the operation, it was found that the texture of the pancreas was hard, and the spleen arteriovenous were considered to be invaded, and the multiple frozen section analysis during the operation showed that the surgical margin was positive. Eventually, the total pancreatectomy plus splenectomy was performed. The postoperative pathological analysis results revealed to the well-moderately differentiated tubular adenocarcinoma. When the condition of patient became stable, the pancreatin and insulin were required for long time. No severe complications occurred. The patient survived well after the surgery and no recurrence was observed for following-up of 3 months. Conclusion With improvement of surgical techniques and enhancement of postoperative management, total pancreatectomy can be used as a treatment for pancreatic cancer and it is still safe and feasible.

Citation： HUANG Yayun, WANG Haijiu, ZHANG Lingqiang, WANG Zhixin, Yangdancairang, REN Li, ZHOU Ying, FAN Haining, HOU Lizhao. Total pancreatectomy plus splenectomy in treatment for pancreatic cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1353-1359. doi: 10.7507/1007-9424.201806076 Copy

1.	張師容, 靳偉, 劉亮, 等. 2017 年胰腺癌基礎研究及診療新進展. 中國癌癥雜志, 2018, 28(1): 1-10.
2.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin, 2018, 68(1): 7-30.
3.	Kamisawa T, Wood LD, Itoi T, et al. Pancreatic cancer. Lancet, 2016, 388(10039): 73-85.
4.	Chen W, Zheng R, Zhang S, et al. Cancer incidence and mortality in China in 2013: an analysis based on urbanization level. Chin J Cancer Res, 2017, 29(1): 1-10.
5.	Wolfgang CL, Herman JM, Laheru DA, et al. Recent progress in pancreatic cancer. CA Cancer J Clin, 2013, 63(5): 318-348.
6.	馬臣, 姜永曉, 劉曙正, 等. 中國胰腺癌發病趨勢分析和預測. 中華流行病學雜志, 2013, 34(2): 160-163.
7.	Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
8.	梁廷波, 白雪莉, 李想. 胰腺癌的新輔助治療. 中國普外基礎與臨床雜志, 2018, 25(6): 645-648.
9.	Leung M, Chao NS, Tang PM, et al. Pancreatic kaposiform hemangioendothelioma presenting with duodenal obstruction and kasabach-merritt phenomenon: a neonate cured by whipple operation. European J Pediatr Surg Rep, 2014, 2(1): 7-9.
10.	徐澤寬, 郭峰, 苗毅, 等. 502 例胰十二指腸切除術后主要并發癥的臨床分析. 中華肝膽外科雜志, 2009, 15(11): 809-812.
11.	熊志勇, 徐見亮, 姚志成, 等. 全胰腺切除術治療 Whipple 術后胰腺斷端出血. 中華肝臟外科手術學電子雜志, 2017, 6(3): 177-180.
12.	陳璐, 余日勝. 胰腺癌的影像學診斷及術前可切除性和分期的影像學評估. 臨床肝膽病雜志, 2016, 32(12): 2305-2311.
13.	中華醫學會外科學分會胰腺外科學組. 胰腺癌診治指南(2014). 中華普通外科雜志, 2015, 30(1): 73-79.
14.	Ballehaninna UK, Chamberlain RS. The clinical utility of serum CA19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal. J Gastrointest Oncol, 2012, 3(2): 105-119.
15.	Marrelli D, Caruso S, Pedrazzani C, et al. CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg, 2009, 198(3): 333-339.
16.	呂翼, 魏若征, 吳河水. 胰腺癌的早期診斷. 臨床急診雜志, 2018, 19(3): 149-151.
17.	朱成林, 余安, 黃強. 用于胰頭癌可切除性判斷的術前血清標志物篩選. 中國普通外科雜志, 2017, 26(3): 265-270.
18.	Ramacciato G, Nigri G, Petrucciani N, et al. Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients. Ann Surg Oncol, 2016, 23(6): 2028-2037.
19.	曲鳳智, 王剛, 孫備, 等. 臨界可切除胰腺癌新輔助治療的研究進展. 中華肝膽外科雜志, 2015, 21(3): 206-209.
20.	中華醫學會外科學分會, 中華醫學會麻醉學分會. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
21.	于浩鵬, 黃子星, 宋彬. 胰腺癌的影像學診斷進展. 中國普外基礎與臨床雜志, 2017, 24(4): 502-506.
22.	Takeshita K, Kutomi K, Haruyama T, et al. Imaging of early pancreatic cancer on multidetector row helical computed tomography. Br J Radiol, 2010, 83(994): 823-830.
23.	Hijioka S, Ikari T, Kamei A, et al. CT and MRI findings with contrast enhancement of small pancreatic adenocarcinoma in the late phase. Hepatogastroenterology, 2007, 54(74): 389-392.
24.	Xiao Z, Luo G, Liu C, et al. Molecular mechanism underlying lymphatic metastasis in pancreatic cancer. Biomed Res Int, 2014, 2014: 925845.
25.	王瀾, 劉麗虹, 韓春, 等. 依據 CT 及 MRI 確定區域淋巴結轉移的病理對照研究. 中華放射腫瘤學雜志, 2015, 24(5): 493-496.
26.	Low G, Panu A, Millo N, et al. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics, 2011, 31(4): 993-1015.
27.	Motosugi U, Ichikawa T, Morisaka H, et al. Detection of pancreatic carcinoma and liver metastases with gadoxetic acid-enhanced MR imaging: comparison with contrast-enhanced multi-detector row CT. Radiology, 2011, 260(2): 446-453.
28.	張鐸賢, 董紅錳, 賀強, 等. 聯合血管切除的胰十二指腸切除術研究進展和經驗總結. 中華肝膽外科雜志, 2015, 21(9): 644-648.
29.	王成鋒. 如何實施成功的胰腺癌手術. 中華醫學雜志, 2011, 91(44): 3100-3102.
30.	Ryska M, Rudi? J. Total pancreatectomy for pancreatic malignancy—from history to the present day. Rozhl Chir, Fall, 2016, 95(10): 345-349.
31.	Mirkin KA, Hollenbeak CS, Gusani NJ, et al. Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer. Am J Surg, 2017, 214(1): 80-88.
32.	宗可, 彭承宏. 胰腺腫瘤外科治療中全胰腺切除的作用. 外科理論與實踐, 2016, 21(5): 443-445.
33.	田龍夫, 崔云峰, 馬波, 等. 胰腺癌根治術后聯合化療藥物治療對患者生存期的影響: 系統評價和Meta分析. 湖北民族學院學報(醫學版), 2017, 34(4): 31-35.
34.	白雪莉, 馬濤, 梁廷波. 2016 年 NCCN 胰腺癌臨床實踐指南(V1 版)更新內容解讀. 中國實用外科雜志, 2016, 36(8): 870-871.

1. 張師容, 靳偉, 劉亮, 等. 2017 年胰腺癌基礎研究及診療新進展. 中國癌癥雜志, 2018, 28(1): 1-10.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin, 2018, 68(1): 7-30.
3. Kamisawa T, Wood LD, Itoi T, et al. Pancreatic cancer. Lancet, 2016, 388(10039): 73-85.
4. Chen W, Zheng R, Zhang S, et al. Cancer incidence and mortality in China in 2013: an analysis based on urbanization level. Chin J Cancer Res, 2017, 29(1): 1-10.
5. Wolfgang CL, Herman JM, Laheru DA, et al. Recent progress in pancreatic cancer. CA Cancer J Clin, 2013, 63(5): 318-348.
6. 馬臣, 姜永曉, 劉曙正, 等. 中國胰腺癌發病趨勢分析和預測. 中華流行病學雜志, 2013, 34(2): 160-163.
7. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
8. 梁廷波, 白雪莉, 李想. 胰腺癌的新輔助治療. 中國普外基礎與臨床雜志, 2018, 25(6): 645-648.
9. Leung M, Chao NS, Tang PM, et al. Pancreatic kaposiform hemangioendothelioma presenting with duodenal obstruction and kasabach-merritt phenomenon: a neonate cured by whipple operation. European J Pediatr Surg Rep, 2014, 2(1): 7-9.
10. 徐澤寬, 郭峰, 苗毅, 等. 502 例胰十二指腸切除術后主要并發癥的臨床分析. 中華肝膽外科雜志, 2009, 15(11): 809-812.
11. 熊志勇, 徐見亮, 姚志成, 等. 全胰腺切除術治療 Whipple 術后胰腺斷端出血. 中華肝臟外科手術學電子雜志, 2017, 6(3): 177-180.
12. 陳璐, 余日勝. 胰腺癌的影像學診斷及術前可切除性和分期的影像學評估. 臨床肝膽病雜志, 2016, 32(12): 2305-2311.
13. 中華醫學會外科學分會胰腺外科學組. 胰腺癌診治指南(2014). 中華普通外科雜志, 2015, 30(1): 73-79.
14. Ballehaninna UK, Chamberlain RS. The clinical utility of serum CA19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal. J Gastrointest Oncol, 2012, 3(2): 105-119.
15. Marrelli D, Caruso S, Pedrazzani C, et al. CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg, 2009, 198(3): 333-339.
16. 呂翼, 魏若征, 吳河水. 胰腺癌的早期診斷. 臨床急診雜志, 2018, 19(3): 149-151.
17. 朱成林, 余安, 黃強. 用于胰頭癌可切除性判斷的術前血清標志物篩選. 中國普通外科雜志, 2017, 26(3): 265-270.
18. Ramacciato G, Nigri G, Petrucciani N, et al. Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients. Ann Surg Oncol, 2016, 23(6): 2028-2037.
19. 曲鳳智, 王剛, 孫備, 等. 臨界可切除胰腺癌新輔助治療的研究進展. 中華肝膽外科雜志, 2015, 21(3): 206-209.
20. 中華醫學會外科學分會, 中華醫學會麻醉學分會. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
21. 于浩鵬, 黃子星, 宋彬. 胰腺癌的影像學診斷進展. 中國普外基礎與臨床雜志, 2017, 24(4): 502-506.
22. Takeshita K, Kutomi K, Haruyama T, et al. Imaging of early pancreatic cancer on multidetector row helical computed tomography. Br J Radiol, 2010, 83(994): 823-830.
23. Hijioka S, Ikari T, Kamei A, et al. CT and MRI findings with contrast enhancement of small pancreatic adenocarcinoma in the late phase. Hepatogastroenterology, 2007, 54(74): 389-392.
24. Xiao Z, Luo G, Liu C, et al. Molecular mechanism underlying lymphatic metastasis in pancreatic cancer. Biomed Res Int, 2014, 2014: 925845.
25. 王瀾, 劉麗虹, 韓春, 等. 依據 CT 及 MRI 確定區域淋巴結轉移的病理對照研究. 中華放射腫瘤學雜志, 2015, 24(5): 493-496.
26. Low G, Panu A, Millo N, et al. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics, 2011, 31(4): 993-1015.
27. Motosugi U, Ichikawa T, Morisaka H, et al. Detection of pancreatic carcinoma and liver metastases with gadoxetic acid-enhanced MR imaging: comparison with contrast-enhanced multi-detector row CT. Radiology, 2011, 260(2): 446-453.
28. 張鐸賢, 董紅錳, 賀強, 等. 聯合血管切除的胰十二指腸切除術研究進展和經驗總結. 中華肝膽外科雜志, 2015, 21(9): 644-648.
29. 王成鋒. 如何實施成功的胰腺癌手術. 中華醫學雜志, 2011, 91(44): 3100-3102.
30. Ryska M, Rudi? J. Total pancreatectomy for pancreatic malignancy—from history to the present day. Rozhl Chir, Fall, 2016, 95(10): 345-349.
31. Mirkin KA, Hollenbeak CS, Gusani NJ, et al. Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer. Am J Surg, 2017, 214(1): 80-88.
32. 宗可, 彭承宏. 胰腺腫瘤外科治療中全胰腺切除的作用. 外科理論與實踐, 2016, 21(5): 443-445.
33. 田龍夫, 崔云峰, 馬波, 等. 胰腺癌根治術后聯合化療藥物治療對患者生存期的影響: 系統評價和Meta分析. 湖北民族學院學報(醫學版), 2017, 34(4): 31-35.
34. 白雪莉, 馬濤, 梁廷波. 2016 年 NCCN 胰腺癌臨床實踐指南(V1 版)更新內容解讀. 中國實用外科雜志, 2016, 36(8): 870-871.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Total pancreatectomy plus splenectomy in treatment for pancreatic cancer

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