Popiela T, Kedra B, Sierzega M, Kubisz A
Department of General and GI Surgery, Jagiellonian University, Krakow, Poland.
Zentralbl Chir. 2002 Nov;127(11):965-70. doi: 10.1055/s-2002-35760.
In spite of dynamic development of modern diagnostic and therapeutic methods, the long-term results of surgical therapy in pancreatic cancer are still unsatisfying. The aim of this study was to analyse long-term results of surgical palliation for pancreatic cancer in a pancreatic surgery centre.
We performed a retrospective analysis of 418 patients who underwent non-resective, palliative procedures for pancreatic cancer between 1975 and 1999. In order to compare two consecutive periods of time, the patients were divided in 2 groups; group I treated from 1975 to 1990 (n = 204), and group II from 1991 to 1999 (n = 214).
Of all patients qualified for surgery, 281 (67.2 %) underwent surgical bypass, 107 (25.6 %) laparotomy, and in 30 cases surgical intervention was limited to implantation of endoprosthesis. A significant tendency towards double (i. e. biliary and gastric) anastomosis was observed (32.3 % vs. 74.8 %; p < 0.01) in patients who underwent bypass procedures. The postoperative morbidity was 16.3 %. The postoperative mortality rate was 5.7 % and significantly (p < 0.01) decreased from 10.3 % (group I) to 1.4 % (group II). No differences neither in mortality nor morbidity related to the type of performed surgery were found. The mean time of hospital stay was 15.5 +/- 6.9 days and showed no differences related to the type of intervention. Jaundice or symptoms of gastric outlet obstruction were observed in 16 % of patients in the follow-up period and concomitantly performed biliary and gastric bypasses were associated with the lowest rate of the late gastrointestinal obstruction (4 %). The median survival time was 169 days and only 4 % of patients survived 12 months. The univariate analysis of prognostic factors showed that location and stage of the tumour, the type of surgical intervention and bypass procedure influenced 1-year survival. The multivariate analysis using Cox proportional hazard model proved that only stage and location of the tumour had independent prognostic value.
Surgical palliation for pancreatic cancer can be performed with acceptable morbidity and mortality rates. For tumours located in the head and body of the pancreas combined biliary and gastric bypass should be preferred. For cancers located in the tail of the pancreas gastric bypass should be performed routinely. Because surgical palliation can prevent gastric outlet obstruction by gastroenterostomy, endoscopic biliary stenting should be only performed in patients with pancreatic head cancers and simultaneous evidence of distal metastases as well as in older patients with high comorbidity.
尽管现代诊断和治疗方法不断发展，但胰腺癌手术治疗的长期效果仍不尽人意。本研究旨在分析一家胰腺手术中心胰腺癌手术姑息治疗的长期效果。
我们对1975年至1999年间接受胰腺癌非切除性姑息手术的418例患者进行了回顾性分析。为比较两个连续时间段，将患者分为两组；第一组在1975年至1990年接受治疗（n = 204），第二组在1991年至1999年接受治疗（n = 214）。
在所有符合手术条件的患者中，281例（67.2%）接受了手术旁路，107例（25.6%）接受了剖腹手术，30例手术干预仅限于植入内支架。在接受旁路手术的患者中，观察到显著的双重（即胆道和胃）吻合趋势（32.3%对74.8%；p < 0.01）。术后发病率为16.3%。术后死亡率为5.7%，并从10.3%（第一组）显著（p < 0.01）降至1.4%（第二组）。未发现与所实施手术类型相关的死亡率和发病率差异。平均住院时间为15.5 +/- 6.9天，且与干预类型无关。随访期间，有16%的患者出现黄疸或胃出口梗阻症状，同时进行胆道和胃旁路手术的患者晚期胃肠道梗阻发生率最低（4%）。中位生存时间为169天，只有4%的患者存活12个月。预后因素的单因素分析表明，肿瘤的位置和分期、手术干预类型和旁路手术影响1年生存率。使用Cox比例风险模型的多因素分析证明，只有肿瘤的分期和位置具有独立的预后价值。
胰腺癌手术姑息治疗可以在可接受的发病率和死亡率下进行。对于位于胰头和胰体的肿瘤，应优先选择联合胆道和胃旁路手术。对于位于胰尾的癌症，应常规进行胃旁路手术。由于手术姑息治疗可以通过胃肠造口术预防胃出口梗阻，内镜胆道支架置入术仅应在患有胰头癌且同时有远处转移证据的患者以及合并症高的老年患者中进行。
