Shapiro T M
Ann Surg. 1975 Dec;182(6):715-21. doi: 10.1097/00000658-197512000-00010.
A series of 297 patients with adenocarcinoma of the head of the pancreas was reviewed. Forty-eight patients was identified with disease limited to the pancreas or adjacent tissues. Twenty-four patients underwent Whipple resection. A second group of 24 patients underwent elective biliary bypass. No patient had liver, omental or peritoneal metastases. All cases of ampullary carcinoma and islet cell tumors were excluded. Assessment of clinical and laboratory parameters revealed the two groups to be statistically comparable. There were no 5-year survivors in either groups. Mean duration of survival was not significantly different. Life table analysis showed no significant difference between the survival rates of the two groups. Frequency of clinic followup, rehospitalization and reexploration were used to assess palliation. Success of palliation was poor in both groups and no statistically significant differences were noted. Surgical mortality in the resected group was 8% and did not differ from the 4% surgical mortality in the bypass group. Surgical morbidity was significantly higher in the resected group. Implications of this data in the management of patients with resectable carcinoma of the pancreas are discussed.
回顾了297例胰头腺癌患者。48例患者被确定疾病局限于胰腺或邻近组织。24例患者接受了惠普尔手术。另一组24例患者接受了择期胆肠吻合术。所有患者均无肝、网膜或腹膜转移。所有壶腹癌和胰岛细胞瘤病例均被排除。临床和实验室参数评估显示两组在统计学上具有可比性。两组均无5年生存者。平均生存期无显著差异。生命表分析显示两组生存率无显著差异。采用临床随访频率、再次住院率和再次探查率来评估姑息治疗效果。两组的姑息治疗效果均较差，且未发现统计学上的显著差异。切除组的手术死亡率为8%，与吻合术组4%的手术死亡率无差异。切除组的手术发病率显著更高。讨论了该数据对可切除胰腺癌患者管理的意义。
