Georgescu St O, Neacşu C N, Vintilă D, Popa P, Florea N, Mihailovici M S
1st Surgical Clinic, Sf. Spiridon Hospital, Gr. T. Popa University of Medicine and Pharmacy Iaşi, Romania.
Chirurgia (Bucur). 2009 Nov-Dec;104(6):697-700.
The ampulla of Vater is a junction with four histologic epithelial types: ampullary, duodenal, pancreatic and biliary. The tumors of this region are named periampullary adenocarcinomas, but the histologic type of these malignancies seems to have an important significance for survival.
Our purpose is to determine whether the histologic type of the resectable vaterian adenocarcinomas is a prognostic factor.
We reviewed the medical records of 38 patients who underwent RO-R1 pancreatoduodenectomy for periampullary adenocarcinomas between 1998 and 2007 in one single surgical center. The histopathologic reports and the microscopic samples were reevaluated independently by two senior pathologists. Using our database we assessed the overall survival based on histologic type, tumor stage, lymph nodes involvement, tumor size and the level of differentiation.
The histologic type of the adenocarcinomas was intestinal in 23 cases (60.5%) and pancreatobiliary in 15 cases (39.5%). The median overall survival was significantly higher in patients with well differentiate intestinal-type in T1-T2 stage without nodes involvement. In a multivariable Cox regression analysis the regional lymph nodes involvement and the differentiation degree remained significant prognostic factors.
The intestinal type of periampullary adenocarcinomas has a long survival, but the lymph nodes involvement and the lower degree of differentiation are associated with a high risk of death in these malignancies.
壶腹是一个由四种组织学上皮类型构成的交界部位，即壶腹型、十二指肠型、胰腺型和胆管型。该区域的肿瘤被称为壶腹周围腺癌，但其组织学类型似乎对生存率具有重要意义。
我们的目的是确定可切除的 Vater 腺癌的组织学类型是否为一个预后因素。
我们回顾了 1998 年至 2007 年期间在一个单一外科中心接受 RO-R1 胰十二指肠切除术治疗壶腹周围腺癌的 38 例患者的病历。两位资深病理学家独立重新评估了组织病理学报告和显微镜样本。利用我们的数据库，我们根据组织学类型、肿瘤分期、淋巴结受累情况、肿瘤大小和分化程度评估了总生存率。
腺癌的组织学类型为肠型的有 23 例（60.5%），胰胆管型的有 15 例（39.5%）。在 T1-T2 期且无淋巴结受累的高分化肠型患者中，中位总生存率显著更高。在多变量 Cox 回归分析中，区域淋巴结受累和分化程度仍然是显著的预后因素。
壶腹周围腺癌的肠型生存期长，但在这些恶性肿瘤中，淋巴结受累和低分化程度与高死亡风险相关。
