{"title":"放射学可切除胰腺导管腺癌患者开腹手术发现远处转移的相关风险因素分析","authors":"Pipit Burasakarn MD, PhD, Kwanchanok Yochum MD, Sermsak Hongjinda MD, Anuparp Thienhiran MD, Pusit Fuengfoo MD","doi":"10.1111/1744-1633.12669","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>This study aimed to evaluate the preoperative risk factors in patients with radiologically resectable pancreatic ductal adenocarcinomas (PDACs), deemed to be unresectable intraoperatively.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Data on patients radiologically diagnosed with resectable PDACs and subsequently underwent pancreatectomy between January 2020 and December 2021 were retrospectively collected. Preoperative risk factors were also analysed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Fifty-three patients with resectable PDAC who underwent laparotomy for curative intent were divided into the no-metastases (n = 32) and distant metastases (n = 21) groups. Univariate analysis identified factors associated with distant metastases found intraoperatively, such as significant weight loss (odds ratio [OR] 5.29, <i>P</i> = .02), tumour size >35 mm (OR 4.15, <i>P</i> = .017), tumours located at the body and tail of the pancreas (OR 6, <i>P</i> = .041), superior mesenteric vein (SMV) abutment from the tumour (OR 7.5, <i>P</i> = .02), serum carbohydrate antigen 19-9 > 385 IU/mL (OR 3.58, <i>P</i> = .031) and serum carcinoembryonic antigen (CEA) levels >9 IU/mL. However, multivariate analysis showed that only significant weight loss (adjusted OR 27.19, <i>P</i> = .011), SMV abutment from the tumour (adjusted OR 52.64, <i>P</i> = .01) and serum CEA levels >9 IU/mL were associated with distant metastases found intraoperatively.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Significant weight loss, SMV abutment and serum CEA levels of >9 IU/mL were intraoperatively associated with distant metastases. Staging laparoscopy and positron emission tomography–computed tomography may reduce unnecessary laparotomies and change clinical management in these patients.</p>\n </section>\n </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"28 2","pages":"76-81"},"PeriodicalIF":0.3000,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Analysis of risk factors associated with distant metastasis detected at laparotomy in patients with radiologically resectable pancreatic ductal adenocarcinoma\",\"authors\":\"Pipit Burasakarn MD, PhD, Kwanchanok Yochum MD, Sermsak Hongjinda MD, Anuparp Thienhiran MD, Pusit Fuengfoo MD\",\"doi\":\"10.1111/1744-1633.12669\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>This study aimed to evaluate the preoperative risk factors in patients with radiologically resectable pancreatic ductal adenocarcinomas (PDACs), deemed to be unresectable intraoperatively.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Data on patients radiologically diagnosed with resectable PDACs and subsequently underwent pancreatectomy between January 2020 and December 2021 were retrospectively collected. Preoperative risk factors were also analysed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Fifty-three patients with resectable PDAC who underwent laparotomy for curative intent were divided into the no-metastases (n = 32) and distant metastases (n = 21) groups. Univariate analysis identified factors associated with distant metastases found intraoperatively, such as significant weight loss (odds ratio [OR] 5.29, <i>P</i> = .02), tumour size >35 mm (OR 4.15, <i>P</i> = .017), tumours located at the body and tail of the pancreas (OR 6, <i>P</i> = .041), superior mesenteric vein (SMV) abutment from the tumour (OR 7.5, <i>P</i> = .02), serum carbohydrate antigen 19-9 > 385 IU/mL (OR 3.58, <i>P</i> = .031) and serum carcinoembryonic antigen (CEA) levels >9 IU/mL. However, multivariate analysis showed that only significant weight loss (adjusted OR 27.19, <i>P</i> = .011), SMV abutment from the tumour (adjusted OR 52.64, <i>P</i> = .01) and serum CEA levels >9 IU/mL were associated with distant metastases found intraoperatively.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Significant weight loss, SMV abutment and serum CEA levels of >9 IU/mL were intraoperatively associated with distant metastases. Staging laparoscopy and positron emission tomography–computed tomography may reduce unnecessary laparotomies and change clinical management in these patients.</p>\\n </section>\\n </div>\",\"PeriodicalId\":51190,\"journal\":{\"name\":\"Surgical Practice\",\"volume\":\"28 2\",\"pages\":\"76-81\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2023-11-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1744-1633.12669\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Practice","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1744-1633.12669","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
Analysis of risk factors associated with distant metastasis detected at laparotomy in patients with radiologically resectable pancreatic ductal adenocarcinoma
Purpose
This study aimed to evaluate the preoperative risk factors in patients with radiologically resectable pancreatic ductal adenocarcinomas (PDACs), deemed to be unresectable intraoperatively.
Methods
Data on patients radiologically diagnosed with resectable PDACs and subsequently underwent pancreatectomy between January 2020 and December 2021 were retrospectively collected. Preoperative risk factors were also analysed.
Results
Fifty-three patients with resectable PDAC who underwent laparotomy for curative intent were divided into the no-metastases (n = 32) and distant metastases (n = 21) groups. Univariate analysis identified factors associated with distant metastases found intraoperatively, such as significant weight loss (odds ratio [OR] 5.29, P = .02), tumour size >35 mm (OR 4.15, P = .017), tumours located at the body and tail of the pancreas (OR 6, P = .041), superior mesenteric vein (SMV) abutment from the tumour (OR 7.5, P = .02), serum carbohydrate antigen 19-9 > 385 IU/mL (OR 3.58, P = .031) and serum carcinoembryonic antigen (CEA) levels >9 IU/mL. However, multivariate analysis showed that only significant weight loss (adjusted OR 27.19, P = .011), SMV abutment from the tumour (adjusted OR 52.64, P = .01) and serum CEA levels >9 IU/mL were associated with distant metastases found intraoperatively.
Conclusion
Significant weight loss, SMV abutment and serum CEA levels of >9 IU/mL were intraoperatively associated with distant metastases. Staging laparoscopy and positron emission tomography–computed tomography may reduce unnecessary laparotomies and change clinical management in these patients.
期刊介绍：
Surgical Practice is a peer-reviewed quarterly journal, which is dedicated to the art and science of advances in clinical practice and research in surgery. Surgical Practice publishes papers in all fields of surgery and surgery-related disciplines. It consists of sections of history, leading articles, reviews, original papers, discussion papers, education, case reports, short notes on surgical techniques and letters to the Editor.
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