Testi W, Coratti A, Tani F, Lorenzi M, Poggialini M, Genovese A, Spagnulo M, Terreni C, Picchianti D, Stefanoni M, Mancini S
Istituto di Chirurgia Generale e Specialità Chirurgiche, Università degli Studi, Siena.
Minerva Chir. 2000 Jul-Aug;55(7-8):505-12.
Currently, pancreatic exocrine carcinoma presents high mortality, poor survival after curative surgery and poor resectability rates at the time of diagnosis. The factors which mostly influence prognosis and therapeutic management (curative surgery or palliative treatments) of the patient affected by pancreatic carcinoma, particularly the peroperative stage, are analyzed and discussed in this article.
From 1969 to 1997, 142 patients with pancreatic ductal carcinoma were admitted to our Department: at the time of diagnosis only 32 patients (22.5%) were considered resectable, and 30 pancreaticoduodenectomies (PD), 1 distal pancreatectomy (DP) and 1 total pancreatectomy (TP) were performed.
Postoperative morbidity and mortality was 53.1% and 12.5% respectively; the survival at 1, 3 and 5 years was 45.5%, 36.4% and 17.6% respectively. The worst prognosis was seen in N+ and T4 patients, with a mean survival of 9 and 10 months.
On the basis of these results and of the literature, the indications for curative surgery, the operative strategy and the lymphoadenectomy extension are discussed: these problems are still open and not resolved definitively. The authors conclude by indicating the need for curative surgery for T1/2 N0 M0 tumors: for T3/4 and/or N+ tumors a careful evaluation of single case is necessary, because of high risk/benefit rate. Pancreatic resections (PD, DP) and standard lymphoadenectomy (D1) are performed by the authors, rather than total pancreatectomy and radical lymphadenectomy (D2-3).
目前，胰腺外分泌癌死亡率高，根治性手术后生存率低，诊断时可切除率低。本文分析并讨论了影响胰腺癌患者预后及治疗管理（根治性手术或姑息治疗）的因素，尤其是手术期分期。
1969年至1997年，142例胰腺导管癌患者入住我科：诊断时仅32例（22.5%）被认为可切除，行30例胰十二指肠切除术（PD）、1例远端胰腺切除术（DP）和1例全胰腺切除术（TP）。
术后发病率和死亡率分别为53.1%和12.5%；1年、3年和5年生存率分别为45.5%、36.4%和17.6%。N+和T4患者预后最差，平均生存期为9个月和10个月。
基于这些结果和文献，讨论了根治性手术的适应证、手术策略和淋巴结清扫范围：这些问题仍未明确解决。作者指出，对于T1/2 N0 M0肿瘤需要进行根治性手术；对于T3/4和/或N+肿瘤，由于风险/获益率高，需要对单个病例进行仔细评估。作者采用胰腺切除术（PD、DP）和标准淋巴结清扫术（D1），而非全胰腺切除术和根治性淋巴结清扫术（D2-3）。
