Petrova Ekaterina, Rückert Felix, Zach Sebastian, Shen YinFeng, Weitz Jürgen, Grützmann Robert, Wittel Uwe A, Makowiec Frank, Hopt Ulrich T, Bronsert Peter, Kühn Florian, Rau Bettina M, Izrailov Roman E, Khatkov Igor E, Lapshyn Hryhoriy, Bolm Louisa, Bausch Dirk, Keck Tobias, Wellner Ulrich F, Seifert Gabriel
Clinic of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Department of Surgery, University Medical Center Mannheim, Mannheim, Germany.
Langenbecks Arch Surg. 2017 Aug;402(5):831-840. doi: 10.1007/s00423-017-1590-9. Epub 2017 Jun 13.
Pancreatoduodenectomy is the most common operative procedure performed for distal bile duct carcinoma. Data on outcome after surgery for this rare malignancy is scarce, especially from western countries. The purpose of this study is to explore the prognostic factors and outcome after pancreatoduodenectomy for distal bile duct carcinoma.
Patients receiving pancreatoduodenectomy for distal bile duct carcinoma were identified from institutional databases of five German and one Russian academic centers for pancreatic surgery. Univariable and multivariable general linear model, Kaplan-Meier method, and Cox regression were used to identify prognostic factors for postoperative mortality and overall survival.
N = 228 patients operated from 1994 to 2015 were included. Reoperation (OR 5.38, 95%CI 1.51-19.22, p = 0.010), grade B/C postpancreatectomy hemorrhage (OR 3.73, 95%CI 1.13-12.35, p = 0.031), grade B/C postoperative pancreatic fistula (OR 4.29, 95%CI 1.25-14.72, p = 0.038), and advanced age (OR 4.00, 95%CI 1.12-14.03, p = 0.033) were independent risk factors for in-hospital mortality in multivariable analysis. Median survival was 29 months, 5-year survival 27%. Positive resection margin (HR 2.07, 95%CI 1.29-3.33, p = 0.003), high tumor grade (HR 1.71, 95%CI 1.13-2.58, p = 0.010), lymph node (HR 1.68, 95%CI 1.13-2.51, p = 0.011), and distant metastases (HR 2.70, 95%CI 1.21-5.58, p = 0.014), as well as severe non-fatal postoperative complications (HR 1.64, 95%CI 1.04-2.58, p = 0.033) were independent negative prognostic factors for survival in multivariable analysis.
Distant metastases and positive resection margin are the strongest negative prognostic factors for survival after pancreatoduodenectomy for distal bile duct carcinoma; thus, surgery with curative intent is only warranted in patients with local disease, where R0 resection is feasible.
胰十二指肠切除术是治疗远端胆管癌最常见的手术方式。关于这种罕见恶性肿瘤手术后的预后数据稀缺，尤其是来自西方国家的数据。本研究的目的是探讨远端胆管癌胰十二指肠切除术后的预后因素及结局。
从德国五个和俄罗斯一个胰腺手术学术中心的机构数据库中识别出接受远端胆管癌胰十二指肠切除术的患者。采用单变量和多变量一般线性模型、Kaplan-Meier法和Cox回归分析来确定术后死亡率和总生存期的预后因素。
纳入了1994年至2015年期间接受手术的228例患者。再次手术（比值比5.38，95%置信区间1.51 - 19.22，p = 0.010）、B/C级胰十二指肠切除术后出血（比值比3.73，95%置信区间1.13 - 12.35，p = 0.031）、B/C级术后胰瘘（比值比4.29，95%置信区间1.25 - 14.72，p = 0.038）和高龄（比值比4.00，95%置信区间1.12 - 14.03，p = 0.033）是多变量分析中院内死亡的独立危险因素。中位生存期为29个月，5年生存率为27%。切缘阳性（风险比2.07，95%置信区间1.29 - 3.33，p = 0.003）、高肿瘤分级（风险比1.71，95%置信区间1.13 - 2.58，p = 0.010）、淋巴结转移（风险比1.68，95%置信区间1.13 - 2.51，p = 0.011）、远处转移（风险比2.70，95%置信区间1.21 - 5.58，p = 0.014）以及严重的非致命术后并发症（风险比1.64，95%置信区间1.04 - 2.58，p = 0.033）是多变量分析中生存的独立负面预后因素。
远处转移和切缘阳性是远端胆管癌胰十二指肠切除术后生存的最强负面预后因素；因此，仅对局部病变且可行R0切除的患者进行根治性手术才是合理的。
