Schniewind B, Bestmann B, Henne-Bruns D, Faendrich F, Kremer B, Kuechler T
Clinic for General and Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Br J Surg. 2006 Sep;93(9):1099-107. doi: 10.1002/bjs.5371.
This study examined quality of life (QoL) after classical partial pancreaticoduodenectomy (PPD) and pylorus-preserving pancreaticoduodenectomy (PPPD) in patients with adenocarcinoma of the pancreatic head, and also evaluated the influence of extended lymphadenectomy (ELA).
Between January 1993 and March 2004, QoL was analysed in a prospective single-centre study that included 91 patients. Thirty-four patients underwent PPD and 57 had a PPPD. Seventy patients had an ELA and 21 underwent regional lymphadenectomy (RLA). QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire and a pancreatic cancer-specific module. Data were collected before operation and for 24 months after surgery.
The overall 5-year survival rate was 18 percent for all patients and 21 percent in those who had an R0 resection. QoL was impaired for 3-6 months after surgery and then recovered to preoperative levels. There was no significant difference in long-term survival after PPD versus PPPD and ELA versus RLA. Patients who had ELA reported clinically significant higher levels of diarrhoea and pain. PPPD showed a disadvantage in terms of pain.
The surgical techniques of resection and reconstruction did not affect QoL, but extended lymphadenectomy was associated with an impairment in QoL.
本研究调查了胰头腺癌患者接受经典胰十二指肠切除术（PPD）和保留幽门胰十二指肠切除术（PPPD）后的生活质量（QoL），并评估了扩大淋巴结清扫术（ELA）的影响。
在1993年1月至2004年3月期间，对一项前瞻性单中心研究中的91例患者进行了生活质量分析。34例患者接受了PPD，57例接受了PPPD。70例患者接受了ELA，21例接受了区域淋巴结清扫术（RLA）。使用欧洲癌症研究与治疗组织QLQ-C30问卷和胰腺癌特异性模块评估生活质量。在手术前和手术后24个月收集数据。
所有患者的总体5年生存率为18%，R0切除患者为21%。术后3至6个月生活质量受损，然后恢复到术前水平。PPD与PPPD以及ELA与RLA后的长期生存率无显著差异。接受ELA的患者报告腹泻和疼痛的临床显著水平较高。PPPD在疼痛方面表现出劣势。
切除和重建的手术技术不影响生活质量，但扩大淋巴结清扫术与生活质量受损有关。
