Effects of the superior mesenteric artery approach versus the no-touch approach during pancreatoduodenectomy on the mobilization of circulating tumour cells and clusters in pancreatic cancer (CETUPANC): randomized clinical trial.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-10-29 DOI:10.1093/bjsopen/zrae123
Javier Padillo-Ruiz, Cristóbal Fresno, Gonzalo Suarez, Gerardo Blanco, Luis Muñoz-Bellvis, Iago Justo, Maria I García-Domingo, Fabio Ausania, Elena Muñoz-Forner, Alejandro Serrablo, Elena Martin, Luis Díez, Carmen Cepeda, Luis Marin, Jose Alamo, Carmen Bernal, Sheila Pereira, Francisco Calero, Jose Tinoco, Sandra Paterna, Esteban Cugat, Constantino Fondevila, Elisa Diego-Alonso, Diego López-Guerra, Miguel Gomez, Valeria Denninghoff, Luis Sabater
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Abstract

Background: Patients with pancreatic ductal adenocarcinoma present early postoperative systemic metastases, despite complete oncological resection. The aim of this study was to assess two pancreatoduodenectomy approaches with regard to intraoperative circulating tumour cells and cluster mobilization and their potential association with the development of distant metastasis.

Methods: Patients with periampullary tumours who underwent open pancreatoduodenectomy were randomly allocated to either the no-touch approach or the superior mesenteric artery approach. A total of four intraoperative portal vein samples (at the beginning of the intervention, after portal vein disconnection from the tumour, after tumour resection, and before abdominal closure) were collected to measure circulating tumour cells and cluster numbers. Primary outcomes were the intraoperative number of circulating tumour cells and cluster mobilization. Further, their potential impact on 3-year distant metastasis disease-free survival and overall survival was assessed.

Results: A total of 101 patients with periampullary tumours were randomized (51 in the superior mesenteric artery group and 50 in the no-touch group) and 63 patients with pancreatic ductal adenocarcinoma (34 in the superior mesenteric artery group and 29 in the no-touch group) were analysed. Circulating tumour cells and cluster mobilization were similar in both the no-touch group and the superior mesenteric artery group at all time points. There were no significant differences between surgical groups with regard to the median metastasis disease-free survival (12.4 (interquartile range 6.1-not reached) months in the superior mesenteric artery group and 18.1 (interquartile range 12.1-not reached) months in the no-touch group; P = 0.730). Patients with intraoperative cluster mobilization from the beginning to the end of surgery developed significantly more distant metastases within the first year after surgery (P = 0.023). Two intraoperative factors (the superior mesenteric artery approach (P = 0.025) and vein resection (P < 0.001)) were predictive factors for cluster mobilization.

Conclusion: Patients undergoing pancreatoduodenectomy using either the no-touch approach or the superior mesenteric artery approach had similar circulating tumour cells and cluster mobilization and similar overall survival and metastasis disease-free survival. A high intraoperative cluster dissemination during pancreatoduodenectomy was a predictive factor for early metastases in patients with pancreatic ductal adenocarcinoma.

Registration number: NCT03340844 (http://www.clinicaltrials.gov)-CETUPANC trial.

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胰十二指肠切除术中肠系膜上动脉入路与不接触入路对胰腺癌循环肿瘤细胞和团块移动的影响(CETUPANC):随机临床试验。
背景:胰腺导管腺癌患者尽管已完全切除肿瘤,但术后仍会出现早期全身转移。本研究旨在评估两种胰十二指肠切除术的术中循环肿瘤细胞和集群动员情况及其与远处转移发生的潜在关系:方法:胰腺周围肿瘤患者接受开腹胰十二指肠切除术后,随机分配到不接触法或肠系膜上动脉法。共收集了四份术中门静脉样本(干预开始时、门静脉与肿瘤断开后、肿瘤切除后和腹部闭合前),以测量循环肿瘤细胞和集群数量。主要结果是术中循环肿瘤细胞数量和集束移动。此外,还评估了它们对3年远处转移无病生存率和总生存率的潜在影响:共对101名胰腺周围肿瘤患者(肠系膜上动脉组51人,无接触组50人)和63名胰腺导管腺癌患者(肠系膜上动脉组34人,无接触组29人)进行了随机分析。在所有时间点,不触及组和肠系膜上动脉组的循环肿瘤细胞和集群移动情况相似。手术组之间的中位无转移生存期无明显差异(肠系膜上动脉组为 12.4 个月(四分位距为 6.1-未达),无接触组为 18.1 个月(四分位距为 12.1-未达);P = 0.730)。术中从手术开始到结束都进行集束移动的患者在术后第一年内发生远处转移的比例明显更高(P = 0.023)。两个术中因素(肠系膜上动脉入路(P = 0.025)和静脉切除(P < 0.001))是集束移动的预测因素:结论:无论是采用不接触法还是肠系膜上动脉法进行胰十二指肠切除术的患者,其循环肿瘤细胞和团块移动情况相似,总生存率和无转移生存率相似。胰十二指肠切除术中术簇的高扩散率是胰腺导管腺癌患者早期转移的预测因素:NCT03340844 (http://www.clinicaltrials.gov)-CETUPANC 试验。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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