Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, China.
Int J Surg. 2017 Dec;48:134-141. doi: 10.1016/j.ijsu.2017.10.065. Epub 2017 Nov 6.
Total pancreatectomy (TP) is considered a viable option in some selected patients with pancreatic ductaladenocarcinoma (PDAC). The aim of this study was to compare the clinical outcomes between TP and pancreaticoduodenectomy (PD) in patients with PDAC.
A total of 375 patients were selected from our center's database in China and classified into two groups: the PD group (n = 325) and the TP group (n = 50). A matched-pair analysis of the patients was conducted with a ratio of 1:1. Univariate and multivariate survival analyses were performed for overall survival.
Overall morbidity was lower in the PD group than in the TP group (31.4% vs 52%, respectively, P = 0.004). However, no significant difference was observed in major morbidity between the two groups (24.9% vs 30%, P = 0.455). The rates of 5-year overall (P = 0.043) and disease-free (P = 0.037) survival were significantly higher in the PD group. Furthermore, the univariate and multivariate analyses revealed that adjuvant chemotherapy (HR = 0.684, 95%CI = 0.545-0.860, P = 0.001) and margin resection status (HR = 1.666, 95%CI = 1.196-2.321, P = 0.003) were significant prognostic factors. After the matched-pair analysis, there were no significant differences between the two groups regarding postoperative complications and overall survival. However, the matched PD group had greater estimated blood loss (P = 0.037) and blood transfusion (56% vs 36%, P = 0.045).
From our study, the postoperative outcomes and survival time of TP are similar to those of matched PD. It seems reasonable to suggest that TP can be considered as safe, feasible, and efficacious as PD for patients with PDAC.
全胰切除术（TP）被认为是某些特定的胰腺导管腺癌（PDAC）患者的可行选择。本研究的目的是比较 TP 与胰十二指肠切除术（PD）在 PDAC 患者中的临床结果。
从我们中心的中国数据库中选择了 375 名患者，并将其分为两组：PD 组（n=325）和 TP 组（n=50）。对患者进行了 1:1 的匹配对分析。对总生存率进行了单因素和多因素生存分析。
PD 组的总体发病率低于 TP 组（分别为 31.4%和 52%，P=0.004）。然而，两组之间的主要发病率无显著差异（分别为 24.9%和 30%，P=0.455）。PD 组的 5 年总生存率（P=0.043）和无病生存率（P=0.037）显著更高。此外，单因素和多因素分析表明，辅助化疗（HR=0.684，95%CI=0.545-0.860，P=0.001）和切缘状态（HR=1.666，95%CI=1.196-2.321，P=0.003）是显著的预后因素。经过匹配对分析，两组术后并发症和总生存率无显著差异。然而，匹配的 PD 组的估计出血量（P=0.037）和输血（56%比 36%，P=0.045）更大。
根据我们的研究，TP 的术后结果和生存时间与匹配的 PD 相似。似乎可以合理地建议，TP 可以被认为是安全、可行和有效的，与 PD 一样适用于 PDAC 患者。
