Uchida Hiroki, Shibata Kohei, Iwaki Kentaro, Kai Seiichiro, Ohta Masayuki, Kitano Seigo
Department of Surgery I, Oita University, Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita 879-5593, Japan.
Hepatogastroenterology. 2009 Jul-Aug;56(93):1194-8.
BACKGROUND/AIMS: Obstructive jaundice is common symptom of carcinoma of the ampulla of Vater. In the present study we evaluated association between preoperative jaundice and prognosis and possible indication of the minimal surgery.
Clinicopathological features of 50 patients who underwent curative resection were examined retrospectively and statistically analyzed.
Thirty-two of the 50 patients (64%) had preoperative jaundice, and these patients had poorer survival compared with these without jaundice (5 year survival 57.2% vs. 100%, p < 0.01). Preoperative jaundice, serum carbohydrate antigen 19-9 level, pancreatic invasion, lymphatic invasion, venous invasion, perineural invasion, duodenal invasion, margin status, lymph node metastasis, and T stage were shown to be significant prognostic factors. In the 18 patients without preoperative jaundice, lymphatic invasion was significantly related to lymph node metastasis. In addition, 12 of the 14 patients without jaundice and lymphatic invasion were diagnosed as T1N0 (stage IA) disease, and all the tumors were papillary or well-differentiated adenocarcinoma.
Preoperative jaundice may reflect advanced-stage in case of ampullary cancer. Radical surgery may not be necessary in patients without preoperative jaundice if the tumor is diagnosed as a papillary or well-differentiated adenocarcinoma without lymphatic invasion.
背景/目的：梗阻性黄疸是壶腹癌的常见症状。在本研究中，我们评估了术前黄疸与预后之间的关联以及最小手术的可能指征。
回顾性检查并统计分析了50例行根治性切除术患者的临床病理特征。
50例患者中有32例（64%）有术前黄疸，这些患者的生存率低于无黄疸患者（5年生存率57.2%对100%，p<0.01）。术前黄疸、血清糖类抗原19-9水平、胰腺侵犯、淋巴侵犯、静脉侵犯、神经周围侵犯、十二指肠侵犯、切缘状态、淋巴结转移和T分期被证明是重要的预后因素。在18例无术前黄疸的患者中，淋巴侵犯与淋巴结转移显著相关。此外，14例无黄疸且无淋巴侵犯的患者中有12例被诊断为T1N0（IA期）疾病，所有肿瘤均为乳头状或高分化腺癌。
壶腹癌患者术前黄疸可能反映疾病处于晚期。如果肿瘤被诊断为无淋巴侵犯的乳头状或高分化腺癌，对于无术前黄疸的患者可能无需进行根治性手术。
