Bucher Pascal, Chassot Gilles, Durmishi Ymer, Ris Frederic, Morel Philippe
Visceral and Transplantation Surgery Clinic, Department of Surgery, University Hospital Geneva, Switzerland.
Hepatogastroenterology. 2007 Jun;54(76):1239-42.
BACKGROUND/AIMS: Vater's ampulla neoplasms account for 30% of resected bilio-pancreatic confluent tumors. Study aim was to review long-term results of surgical treatment for ampullary neoplasms.
A retrospective review from 1993 to 2002 identified 55 patients admitted for Vater's ampulla neoplasm in our institution. Follow-up was complete for all cases with a median follow-up of 24 (range 2-180) months.
Among the ampullary neoplasms, 10 were adenomas (median age 71) and 45 adenocarcinomas (median age 69). Of the adenomas 60% were treated surgically with excellent long-term results. The resectability rate of ampullary carcinomas was 84%. 34 patients had pancreaticoduodenectomy and 4 ampullectomy. Importantly, the rate of false-negative preoperative biopsies was 45%. Seven patients were treated by stenting or derivation due to poor condition. Actuarial five-year survival rate after pancreatoduodenectomy was 68% (median follow-up 24 months), compared to 0% for other approaches (p < 0.01). After pancreatoduodenectomy, the lymph node status influenced survival, while disease-free survival at 5 years was 85% for NO and 27% for N1 (p < 0.001). Among the pancreatoduodenectomies, 55% consisted of pylorus-preserving procedure which did not influence prognosis compared to absence of pylorus preservation.
Pancreatoduodenectomy remains the gold standard for Vater's ampulla neoplasms resection due to the low sensitivity of diagnostic biopsies for carcinoma detection. Vater's ampulla neoplasms resection by pancreatoduodenectomy is associated with good long-term results; however survival after curative resection is influenced by lymph node status.
背景/目的：壶腹肿瘤占切除的胆胰汇合部肿瘤的30%。本研究旨在回顾壶腹肿瘤手术治疗的长期结果。
回顾性分析1993年至2002年在我院因壶腹肿瘤入院的55例患者。所有病例均完成随访，中位随访时间为24（2 - 180）个月。
在壶腹肿瘤中，10例为腺瘤（中位年龄71岁），45例为腺癌（中位年龄69岁）。60%的腺瘤接受了手术治疗，长期效果良好。壶腹癌的可切除率为84%。34例患者接受了胰十二指肠切除术，4例接受了壶腹切除术。重要的是，术前活检假阴性率为45%。7例患者因病情较差接受了支架置入或改道术。胰十二指肠切除术后的5年精算生存率为68%（中位随访24个月），而其他治疗方法的5年精算生存率为0%（p < 0.01）。胰十二指肠切除术后，淋巴结状态影响生存率，5年无病生存率NO为85%，N1为27%（p < 0.001）。在胰十二指肠切除术中，55%为保留幽门的手术，与未保留幽门相比，不影响预后。
由于诊断性活检对癌的检测敏感性较低，胰十二指肠切除术仍是壶腹肿瘤切除的金标准。胰十二指肠切除术治疗壶腹肿瘤具有良好的长期效果；然而，根治性切除后的生存率受淋巴结状态影响。
