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胰体尾恶性肿瘤的根治性切除与预后。

Radical resection and outcome for malignant tumors of the pancreatic body and tail.

机构信息

Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang Province, China.

出版信息

World J Gastroenterol. 2009 Nov 14;15(42):5346-51. doi: 10.3748/wjg.15.5346.

Abstract

AIM

To analyze the factors influencing radical (R0) resection rate and surgical outcome for malignant tumor of the pancreatic body and tail.

METHODS

The clinical and operative data and follow-up results of 214 pancreatic body and tail cancer patients were analyzed retrospectively.

RESULTS

One hundred and twenty/214 pancreatic body and tail cancer patients underwent surgical treatment; the overall resection rate was 59.2% (71/120), and the R0 resection rate was 40.8% (49/120). Compared with non-R0 treatment, the patients receiving an R0 resection had smaller size tumor (P<0.01), cystadenocarcinoma (P<0.01), less lymph node metastasis (P<0.01), less peri-pancreatic organ involvement (P<0.01) and earlier stage disease (P<0.01). The overall 1-, 3- and 5-year survival rates for pancreatic body and tail cancer patients were 12.7% (25/197), 7.6% (15/197) and 2.5% (5/197), respectively, and ductal adenocarcinoma patients had worse survival rates [15.0% (9/60), 6.7% (4/60) and 1.7% (1/60), respectively] than cystadenocarcinoma patients [53.8% (21/39), 28.2% (11/39) and 10.3% (4/39)] (P<0.01). Moreover, the 1-, 3- and 5-year overall survival rates in patients with R0 resection were 55.3% (26/47), 31.9% (15/47) and 10.6% (5/47), respectively, significantly better than those in patients with palliative resection [9.5% (2/21), 0 and 0] and in patients with bypass or laparotomy [1.2% (1/81), 0 and 0] (P<0.01).

CONCLUSION

Early diagnosis is crucial for increasing the radical resection rate, and radical resection plays an important role in improving survival for pancreatic body and tail cancer patients.

摘要

目的

分析影响胰体尾恶性肿瘤根治性(R0)切除率和手术效果的因素。

方法

回顾性分析 214 例胰体尾癌患者的临床和手术资料及随访结果。

结果

120/214 例胰体尾癌患者接受了手术治疗;总体切除率为 59.2%(71/120),R0 切除率为 40.8%(49/120)。与非 R0 治疗相比,接受 R0 切除的患者肿瘤体积较小(P<0.01)、囊腺癌(P<0.01)、淋巴结转移较少(P<0.01)、胰周器官受累较少(P<0.01)、疾病分期较早(P<0.01)。胰体尾癌患者的总体 1、3、5 年生存率分别为 12.7%(25/197)、7.6%(15/197)和 2.5%(5/197),其中导管腺癌患者的生存率较差[15.0%(9/60)、6.7%(4/60)和 1.7%(1/60)],而囊腺癌患者的生存率较好[53.8%(21/39)、28.2%(11/39)和 10.3%(4/39)](P<0.01)。此外,R0 切除患者的 1、3、5 年总生存率分别为 55.3%(26/47)、31.9%(15/47)和 10.6%(5/47),明显优于姑息性切除患者[9.5%(2/21)、0 和 0]和旁路或剖腹探查患者[1.2%(1/81)、0 和 0](P<0.01)。

结论

早期诊断对提高根治性切除率至关重要,根治性切除对改善胰体尾癌患者的生存至关重要。

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