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.	张师容, 靳伟, 刘亮, 等. 2017 年胰腺癌基础研究及诊疗新进展. 中国癌症杂志, 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.	马臣, 姜永晓, 刘曙正, 等. 中国胰腺癌发病趋势分析和预测. 中华流行病学杂志, 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. 胰腺癌的新辅助治疗. 中国普外基础与临床杂志, 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.	徐泽宽, 郭峰, 苗毅, 等. 502 例胰十二指肠切除术后主要并发症的临床分析. 中华肝胆外科杂志, 2009, 15(11): 809-812.
11.	熊志勇, 徐见亮, 姚志成, 等. 全胰腺切除术治疗 Whipple 术后胰腺断端出血. 中华肝脏外科手术学电子杂志, 2017, 6(3): 177-180.
12.	陈璐, 余日胜. 胰腺癌的影像学诊断及术前可切除性和分期的影像学评估. 临床肝胆病杂志, 2016, 32(12): 2305-2311.
13.	中华医学会外科学分会胰腺外科学组. 胰腺癌诊治指南(2014). 中华普通外科杂志, 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.	吕翼, 魏若征, 吴河水. 胰腺癌的早期诊断. 临床急诊杂志, 2018, 19(3): 149-151.
17.	朱成林, 余安, 黄强. 用于胰头癌可切除性判断的术前血清标志物筛选. 中国普通外科杂志, 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.	曲凤智, 王刚, 孙备, 等. 临界可切除胰腺癌新辅助治疗的研究进展. 中华肝胆外科杂志, 2015, 21(3): 206-209.
20.	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
21.	于浩鹏, 黄子星, 宋彬. 胰腺癌的影像学诊断进展. 中国普外基础与临床杂志, 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.	王澜, 刘丽虹, 韩春, 等. 依据 CT 及 MRI 确定区域淋巴结转移的病理对照研究. 中华放射肿瘤学杂志, 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.	张铎贤, 董红锰, 贺强, 等. 联合血管切除的胰十二指肠切除术研究进展和经验总结. 中华肝胆外科杂志, 2015, 21(9): 644-648.
29.	王成锋. 如何实施成功的胰腺癌手术. 中华医学杂志, 2011, 91(44): 3100-3102.
30.	Ryska M, Rudiš 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. 胰腺肿瘤外科治疗中全胰腺切除的作用. 外科理论与实践, 2016, 21(5): 443-445.
33.	田龙夫, 崔云峰, 马波, 等. 胰腺癌根治术后联合化疗药物治疗对患者生存期的影响: 系统评价和Meta分析. 湖北民族学院学报(医学版), 2017, 34(4): 31-35.
34.	白雪莉, 马涛, 梁廷波. 2016 年 NCCN 胰腺癌临床实践指南(V1 版)更新内容解读. 中国实用外科杂志, 2016, 36(8): 870-871.

1. 张师容, 靳伟, 刘亮, 等. 2017 年胰腺癌基础研究及诊疗新进展. 中国癌症杂志, 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. 马臣, 姜永晓, 刘曙正, 等. 中国胰腺癌发病趋势分析和预测. 中华流行病学杂志, 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. 胰腺癌的新辅助治疗. 中国普外基础与临床杂志, 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. 徐泽宽, 郭峰, 苗毅, 等. 502 例胰十二指肠切除术后主要并发症的临床分析. 中华肝胆外科杂志, 2009, 15(11): 809-812.
11. 熊志勇, 徐见亮, 姚志成, 等. 全胰腺切除术治疗 Whipple 术后胰腺断端出血. 中华肝脏外科手术学电子杂志, 2017, 6(3): 177-180.
12. 陈璐, 余日胜. 胰腺癌的影像学诊断及术前可切除性和分期的影像学评估. 临床肝胆病杂志, 2016, 32(12): 2305-2311.
13. 中华医学会外科学分会胰腺外科学组. 胰腺癌诊治指南(2014). 中华普通外科杂志, 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. 吕翼, 魏若征, 吴河水. 胰腺癌的早期诊断. 临床急诊杂志, 2018, 19(3): 149-151.
17. 朱成林, 余安, 黄强. 用于胰头癌可切除性判断的术前血清标志物筛选. 中国普通外科杂志, 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. 曲凤智, 王刚, 孙备, 等. 临界可切除胰腺癌新辅助治疗的研究进展. 中华肝胆外科杂志, 2015, 21(3): 206-209.
20. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
21. 于浩鹏, 黄子星, 宋彬. 胰腺癌的影像学诊断进展. 中国普外基础与临床杂志, 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. 王澜, 刘丽虹, 韩春, 等. 依据 CT 及 MRI 确定区域淋巴结转移的病理对照研究. 中华放射肿瘤学杂志, 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. 张铎贤, 董红锰, 贺强, 等. 联合血管切除的胰十二指肠切除术研究进展和经验总结. 中华肝胆外科杂志, 2015, 21(9): 644-648.
29. 王成锋. 如何实施成功的胰腺癌手术. 中华医学杂志, 2011, 91(44): 3100-3102.
30. Ryska M, Rudiš 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. 胰腺肿瘤外科治疗中全胰腺切除的作用. 外科理论与实践, 2016, 21(5): 443-445.
33. 田龙夫, 崔云峰, 马波, 等. 胰腺癌根治术后联合化疗药物治疗对患者生存期的影响: 系统评价和Meta分析. 湖北民族学院学报(医学版), 2017, 34(4): 31-35.
34. 白雪莉, 马涛, 梁廷波. 2016 年 NCCN 胰腺癌临床实践指南(V1 版)更新内容解读. 中国实用外科杂志, 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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