Benassai G, Mastrorilli M, Mosella F, Mosella G
Division of General Surgery, University of Naples Federico II, Italy.
J Exp Clin Cancer Res. 1999 Mar;18(1):23-8.
Recent reports have demonstrated a reduction in the morbidity and mortality of pancreatic resections and improvement in the 5-actuarial survival for patients with resected ductal adenocarcinoma. However, the prognosis for patients with lymph node metastases remains uncertain. The purpose of this study is to determine if the presence of lymph node metastases influences the survival in patients with otherwise potentially curable pancreatic head carcinoma. Between January 1974 and December 1995, 340 patients with pancreatic carcinoma, including 238 patients with pancreatic head tumours, were evaluated and treated in our Department. Seventy-seven (32.3%) patients with pancreatic head carcinoma underwent pancreaticoduodenectomy. Ages ranged from 40 to 76 years, with a mean age of 61 years. Fifty patients were male, twenty-seven were female. The overall postoperative mortality rate was 5.2% (4 patients) and morbidity was 23.4%. Median survival following resection was 17 months (range 0 to 79). The estimated 1-, 2-, 3- and 5-year survival were 68.8%, 48.1%, 23.4% and 18.2%, respectively. There were 14 five-year survivors. Of the 77 patients, 25 (32.5%) had negative lymph nodes. The median and 5-year survival in these node-negative patients were 33 months (range 5 to 79) and 40%, respectively. Whereas the median survival and 5-year survival in 52 patients with lymph nodes metastases were 14 months (range 0 to 61) and 7.7%, respectively (P<0.0001). There were 4 five-year survivors in the group of patients with lymph node metastases; in 2 patients was performed extensive lymph node dissection (R2) and in other 2 patients R1 procedure. In the patients with lymph node metastases undergoing R1 resection (n = 39), the 1-, 2- and 5-year survival rates were 48.7%, 23.1% and 5.1%, respectively. Whereas in the patients with positive lymph nodes undergoing R2 resection (n = 14), the 1-, 2- and 5-year survival rates were 92.9%, 64.3% and 14.3%, respectively (P<0.02). As expected, tumour size and margin status in specimen proved to be two significant factors predicting survival. Pancreatoduodenectomy can be performed with low operative mortality. Lymph nodes metastases are found in 67.5% of patient undergoing resection. Pancreaticoduodenectomy offers good palliation for patients with lymph nodes metastases and encouraging long-term survival rates as well as a chance for cure in patients with negative lymph nodes and negative margins of resection.
近期报告显示，胰腺切除术的发病率和死亡率有所降低，接受导管腺癌切除术患者的5年精算生存率有所提高。然而，有淋巴结转移患者的预后仍不确定。本研究的目的是确定淋巴结转移的存在是否会影响其他方面可能可治愈的胰头癌患者的生存。1974年1月至1995年12月期间，我们科室对340例胰腺癌患者进行了评估和治疗，其中包括238例胰头肿瘤患者。77例（32.3%）胰头癌患者接受了胰十二指肠切除术。年龄范围为40至76岁，平均年龄61岁。男性50例，女性27例。总体术后死亡率为5.2%（4例患者），发病率为23.4%。切除术后的中位生存期为17个月（范围0至79个月）。估计的1年、2年、3年和5年生存率分别为68.8%、48.1%、23.4%和18.2%。有14例患者存活5年。在这77例患者中，25例（32.5%）淋巴结阴性。这些淋巴结阴性患者的中位生存期和5年生存率分别为33个月（范围5至79个月）和40%。而52例有淋巴结转移患者的中位生存期和5年生存率分别为14个月（范围0至61个月）和7.7%（P<0.0001）。有淋巴结转移的患者组中有4例存活5年；其中2例患者进行了广泛淋巴结清扫（R2），另外2例患者进行了R1手术。在接受R1切除的有淋巴结转移患者（n = 39）中，1年、2年和5年生存率分别为48.7%、23.1%和5.1%。而在接受R2切除的淋巴结阳性患者（n = 14）中，1年、2年和5年生存率分别为92.9%、64.3%和14.3%（P<0.02）。正如预期的那样，标本中的肿瘤大小和切缘状态被证明是预测生存的两个重要因素。胰十二指肠切除术可在低手术死亡率下进行。在接受切除术的患者中，67.5%发现有淋巴结转移。胰十二指肠切除术为有淋巴结转移的患者提供了良好的缓解，具有令人鼓舞的长期生存率，同时也为淋巴结阴性且切缘阴性的患者提供了治愈的机会。
