Kofokotsios Alexandros, Papazisis Konstantinos, Andronikidis Ioannis, Ntinas Achilleas, Kardassis Dimitrios, Vrochides Dionisios
1 Department of Interventional Gastroenterology.
2 Department of Medical Oncology.
Int Surg. 2015 Jun;100(6):1104-10. doi: 10.9738/INTSURG-D-14-00274.1.
The aim of this study was to evaluate the efficacy of endoscopically placed metal stents in comparison with operative procedures, in patients with obstructive pancreatic head cancer. Endoscopic stenting techniques and materials for gastrointestinal malignancies are constantly improving. Despite this evolution, many still consider operative procedures to be the gold standard for palliation in patients with unresectable obstructive pancreatic head cancer. This is a retrospective study of 52 patients who were diagnosed with obstructive (biliary, duodenal, or both) adenocarcinoma of the pancreatic head. Twenty-nine patients (endoscopy group) underwent endoscopic stenting. Eleven patients (bypass group) underwent biliodigestive bypass. Twelve patients (Whipple group) underwent Whipple operation with curative intent; however, histopathology revealed R1 resection (palliative Whipple). T4 disease was identified in 13 (44.8%), 7 (63.6%), and 3 (25%) patients in the endoscopy, bypass, and Whipple groups, respectively. Metastatic disease was present only in the endoscopy group (n = 12; 41.3%). There was no intervention-related mortality. Median survival was 280 days [95% confidence interval (95% CI), 103, 456 days], 157 days (95% CI, 0, 411 days), and 647 days (95% CI, 300, 993 days) for the endoscopy, bypass, and Whipple groups, respectively (P = 0.111). In patients with obstructive pancreatic head cancer, endoscopic stenting may offer equally good palliation compared with surgical double bypass. The numerically (not statistically) better survival after palliative Whipple might be explained by the smaller tumor burden in this subgroup of patients and not by the superior efficacy of this operation.
本研究旨在评估内镜下放置金属支架与手术治疗相比，对梗阻性胰头癌患者的疗效。用于胃肠道恶性肿瘤的内镜支架置入技术和材料在不断改进。尽管有这种进展，但许多人仍认为手术治疗是不可切除的梗阻性胰头癌患者姑息治疗的金标准。这是一项对52例被诊断为胰头梗阻性（胆管、十二指肠或两者均有）腺癌患者的回顾性研究。29例患者（内镜组）接受了内镜支架置入术。11例患者（旁路组）接受了胆肠吻合术。12例患者（惠普尔组）接受了旨在根治的惠普尔手术；然而，组织病理学显示为R1切除（姑息性惠普尔手术）。内镜组、旁路组和惠普尔组分别有13例（44.8%）、7例（63.6%）和3例（25%）患者被诊断为T4期疾病。仅内镜组存在转移性疾病（n = 12；41.3%）。没有与干预相关的死亡病例。内镜组、旁路组和惠普尔组的中位生存期分别为280天[95%置信区间（95%CI），103，456天]、157天（95%CI，0，411天）和647天（95%CI，300，993天）（P = 0.111）。对于梗阻性胰头癌患者，与手术双旁路相比，内镜支架置入术可能提供同样良好的姑息治疗效果。姑息性惠普尔手术后生存期在数值上（无统计学意义）更好，可能是因为该亚组患者的肿瘤负荷较小，而不是因为该手术的疗效更佳。
