DataSheet_1_Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant.docx

BackgroundEn bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). However, resection of the pancreas is controversial because it may cause serious complications, such as pancreatic fistula or bleeding. Thus, we evaluated the outcomes of distal pancreatectomy (DP) in pancreas-abutting RPS of the left upper quadrant (LUQ).MethodsWe retrospectively reviewed all consecutive patients who underwent surgery for RPS between September 2001 and April 2020. We selected 150 patients with all or part of their tumor located in the LUQ on preoperative computed tomography. Eighty-six patients who had tumors abutting the pancreas were finally enrolled in our study.ResultsFifty-three patients (53/86; 61.6%) were included in the non-DP group, and 33 patients (33/86; 38.4%) were included in the DP group. Total postoperative complications and complication rates for those Clavien–Dindo grade 3 or higher were similar between the non-DP group and DP group (p = 0.290 and p = 0.550). In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients. During multivariate analysis, microscopic pancreatic invasion was deemed a risk factor for local recurrence (p = 0.029). However, there were no significant differences on preoperative computed tomography findings between the pancreatic invasion and non-invasion groups.ConclusionDP is a reasonable procedure for pancreas-abutting RPS located at the LUQ when both complications and complete resection are considered.

背景：对于局限性的后腹膜肉瘤（RPS），建议进行肿瘤及其相邻器官的整块切除术。然而，由于可能引发严重的并发症，如胰腺瘘或出血，胰腺的切除存在争议。因此，本研究评估了左上象限（LUQ）胰腺毗邻的RPS患者行远端胰腺切除术（DP）的预后。方法：我们对2001年9月至2020年4月期间接受RPS手术的所有连续患者进行了回顾性分析。我们选取了术前计算机断层扫描显示肿瘤全部或部分位于LUQ的150名患者。最终，86名肿瘤毗邻胰腺的患者被纳入本研究。结果：53名患者（53/86；61.6%）被纳入非DP组，33名患者（33/86；38.4%）被纳入DP组。两组的总术后并发症和Clavien-Dindo分级3或以上的并发症发生率相似（p = 0.290和p = 0.550）。在DP组中，18.2%的患者（6/33）发生了B级胰腺瘘，但未出现C级胰腺瘘，42.4%的患者（14/33）存在微小的胰腺侵犯。在多因素分析中，微小胰腺侵犯被认为是局部复发的风险因素（p = 0.029）。然而，胰腺侵犯与未侵犯组在术前计算机断层扫描检查结果上并无显著差异。结论：在考虑并发症和完整切除的情况下，DP对于位于LUQ的胰腺毗邻RPS是一种合理的手术方式。