Koslowsky T C, Wilke J, Voiss W, Michaelis S, Balta D, Siedek M
Chirurgische Klinik, St. Elisabeth Krankenhaus, Köln-Hohenlind.
Chirurg. 2001 Jun;72(6):704-9. doi: 10.1007/s001040170127.
High perioperative complication rates in the 1980s led to preferred use of endoscopic therapy for surgical palliation of pancreatic cancer. This encouraged us to analyse our own patients retrospectively.
In the period from 1 January 1992 to 31 December 1998, 253 patients with an exocrine carcinoma of the pancreas were operated on at the St. Elisabeth Hospital Cologne-Hohenlind: 73 patients (28.9%) underwent curative resection (R0) while 180 patients (71.1%) had palliative operative treatment (R1/R2). Palliative resection was performed in 22 patients (8.7%). Intestinal bypass surgery was done in 113 patients (44.7%) as a gastrojejunostomy and in 16 patients (6.3%) as a duodenojejunostomy. A biliodigestive anastomosis was performed in 85 patients (33.6%). This procedure was combined with a gastroenterostomy in 78 patients (30.8%). In 18 patients (7.1%) no surgical palliation was possible and the operation finished as a diagnostic laparotomy.
The overall mortality rate within the first 30 (60) days was 5.5% (12.7%). Patients whose carcinoma had been resected curatively had a 30 (60)-day mortality rate of 2.7% (4.1%), compared to a rate in palliatively treated patients (resection/bypass/probatoria) of 6.7% (16.1%). Patients with palliatively resected tumor had perioperative mortality of 4.5% (4.5%), whereas patients who did not undergo resection had 6.9% (17.7%). The survival rate for curatively resected patients after Kaplan-Meier extrapolation was 64.7% after 1 year and 31.2% and 26.2% after 3 and 5 years, with a median survival time of 552 days. Palliatively operated patients had a survival rate of 19.4%, 2.5% and 0% for 1, 3 and 5 years. Median survival time was 171 days in this situation. Compared to patients without resection (17.4% and 2.0%), patients with palliative resection had survival rates for 1 and 3 years of 40% und 5.9%. After 5 years none of these patients were alive.
Our data show a high success of surgical palliation in pancreatic cancer in centers with a high frequency of pancreatic surgery. Patients that could not be cured (R1/R2), although undergoing extensive procedures, had better survival rates than patients treated with bypass surgery. Perioperative mortality rate was comparatively low. This justifies aggressive surgical management of pancreatic carcinoma.
20世纪80年代围手术期并发症发生率较高，导致内镜治疗成为胰腺癌手术姑息治疗的首选方法。这促使我们对自己的患者进行回顾性分析。
1992年1月1日至1998年12月31日期间，科隆 - 霍恩林德圣伊丽莎白医院对253例胰腺外分泌癌患者进行了手术：73例（28.9%）患者接受了根治性切除（R0），而180例（71.1%）患者接受了姑息性手术治疗（R1/R2）。22例（8.7%）患者进行了姑息性切除。113例（44.7%）患者进行了肠旁路手术，其中胃空肠吻合术113例，十二指肠空肠吻合术16例（6.3%）。85例（33.6%）患者进行了胆肠吻合术。该手术与胃肠吻合术联合进行的有78例（30.8%）。18例（7.1%）患者无法进行手术姑息治疗，手术以诊断性剖腹术结束。
前30（60）天的总死亡率为5.5%（12.7%）。接受根治性切除的患者30（60）天死亡率为2.7%（4.1%），而姑息性治疗患者（切除/旁路/探查）的死亡率为6.7%（16.1%）。接受姑息性切除肿瘤的患者围手术期死亡率为4.5%（4.5%），而未接受切除的患者为6.9%（17.7%）。根治性切除患者经Kaplan-Meier法外推后的1年生存率为64.7%，3年和5年生存率分别为31.2%和26.2%，中位生存时间为552天。接受姑息性手术的患者1年、3年和5年生存率分别为19.4%、2.5%和0%。这种情况下的中位生存时间为171天。与未接受切除的患者（17.4%和2.0%）相比，接受姑息性切除的患者1年和3年生存率分别为40%和5.9%。5年后这些患者均无存活。
我们的数据表明，在胰腺手术频率较高的中心，胰腺癌手术姑息治疗取得了很高的成功率。无法治愈（R1/R2）的患者，尽管接受了广泛的手术，但其生存率高于接受旁路手术的患者。围手术期死亡率相对较低。这证明了对胰腺癌进行积极手术治疗的合理性。
