*Department of General, Visceral, and Transplantation Surgery; †Division of Biostatistics; and ‡Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
Ann Surg. 2015 Mar;261(3):537-46. doi: 10.1097/SLA.0000000000000791.
To assess the long-term survival and quality of life in total pancreatectomies and to identify risk factors for perioperative morbidity and mortality.
Total pancreatectomy may be required in locally advanced or centrally located pancreatic neoplasms to achieve complete tumor clearance, but available data on short- and long-term results are limited.
A total of 434 consecutive total pancreatectomies for primary pancreatic or periampullary tumors were performed between October 2001 and September 2012 at the authors' institution and were prospectively documented and analyzed. Long-term outcome was assessed using Kaplan-Meier and quality of life analysis (EORTC-QLQ-C30 and PAN26). Uni- and multivariate analysis was performed to identify perioperative risk factors and predictors for long-term survival.
Extended total pancreatectomies were performed in 54% of cases, with arterial and portal vein resections in 15% and 32%, respectively. Overall 30-day and in-hospital mortality rates were 3.7% and 7.8%, respectively. High blood loss, long operative time, and arterial resections were independently associated with increased perioperative mortality (P ≤ 0.018). In malignant disease, median and 5-year survival were good for standard total pancreatectomies (28.6 months and 24.3%, respectively) and were significantly impaired after vascular resections (P < 0.001). Poor tumor grading, high American Joint Commission on Cancer tumor stage, age more than 70 years, and an R1 resection were independent prognostic parameters. Long-term global quality of life was comparable with a matched healthy control group.
Standard total pancreatectomy, if needed, is associated with good long-term outcome in pancreatic cancer. Marked surgical morbidity and impaired survival associated with vascular resections reflect the invasiveness of extended total pancreatectomies and the underlying advanced malignant disease.
评估全胰切除术的长期生存和生活质量，并确定围手术期发病率和死亡率的风险因素。
局部晚期或中央型胰腺肿瘤可能需要全胰切除术以实现完全肿瘤清除，但有关短期和长期结果的数据有限。
作者所在机构于 2001 年 10 月至 2012 年 9 月期间对原发性胰腺或胰周肿瘤连续进行了 434 例全胰切除术，并进行了前瞻性记录和分析。使用 Kaplan-Meier 法和生活质量分析（EORTC-QLQ-C30 和 PAN26）评估长期结果。进行单因素和多因素分析，以确定围手术期风险因素和长期生存的预测因素。
54%的病例行扩展全胰切除术，动脉和门静脉切除术分别为 15%和 32%。总体 30 天和住院死亡率分别为 3.7%和 7.8%。高出血量、手术时间长和动脉切除术与围手术期死亡率增加独立相关（P ≤ 0.018）。在恶性疾病中，标准全胰切除术的中位和 5 年生存率良好（分别为 28.6 个月和 24.3%），血管切除术显著降低（P < 0.001）。肿瘤分级差、美国癌症联合委员会肿瘤分期高、年龄大于 70 岁和 R1 切除是独立的预后参数。长期总体生活质量与匹配的健康对照组相当。
如果需要，标准全胰切除术与胰腺癌的良好长期预后相关。血管切除术相关的显著手术发病率和生存受损反映了扩展全胰切除术的侵袭性和潜在的晚期恶性疾病。
