Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
Department of Digestive Surgery and Liver Transplantation, Hôpital Michallon, Grenoble University, Grenoble, France.
Updates Surg. 2021 Apr;73(2):439-450. doi: 10.1007/s13304-021-00981-0. Epub 2021 Jan 24.
The aim of the study was to compare histological features, postoperative outcomes, and long-term prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma. From 2005 to 2017, 188 pancreaticoduodenectomies (pancreatic ductal adenocarcinoma n = 151, distal cholangiocarcinoma n = 37) were included. Postoperative outcomes were compared after matching on pancreatic gland texture and main pancreatic duct size. Matching according to tumor size, lymph node invasion and resection margin was used to compare overall and disease-free survival. Distal cholangiocarcinoma patients had more often "soft" pancreatic gland (P = 0.002) and small size main pancreatic duct (P = 0.001). Pancreatic ductal adenocarcinoma patients had larger tumors (P = 0.009), and higher lymph node ratio (P = 0.017). Severe morbidity (P = 0.023) and clinically relevant pancreatic fistula (P = 0.018) were higher in distal cholangiocarcinoma patients. After matching on gland texture and main pancreatic duct diameter, clinically relevant postoperative pancreatic fistula was still more frequent in distal cholangiocarcinoma patients (P = 0.007). Tumor size > 20 mm was predictive of impaired overall survival (P = 0.024) and disease-free survival (P = 0.003), tumor differentiation (P = 0.027) was predictive of impaired overall survival. Survival outcomes for distal cholangiocarcinoma and pancreatic ductal cholangiocarcinoma were similar after matching patients according to tumor size, lymph node invasion and resection margin. Long-term outcomes after pancreaticoduodenectomy for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma patients are similar. Postoperative course is more complicated after pancreaticoduodenectomy for distal cholangiocarcinoma than pancreatic ductal adenocarcinoma. After pancreaticoduodenectomy, patients with distal cholangiocarcinoma and pancreatic ductal adenocarcinoma have similar long-term oncological outcomes.
本研究旨在比较胰十二指肠切除术治疗远端胆管癌和胰管腺癌的组织学特征、术后结果和长期预后因素。2005 年至 2017 年，共纳入 188 例胰十二指肠切除术（胰管腺癌 n=151，远端胆管癌 n=37）。在匹配胰腺腺质地和主胰管大小后比较术后结果。根据肿瘤大小、淋巴结侵犯和切缘进行匹配以比较总生存期和无病生存期。远端胆管癌患者的胰腺腺质地更软（P=0.002），主胰管更小（P=0.001）。胰管腺癌患者的肿瘤更大（P=0.009），淋巴结比率更高（P=0.017）。远端胆管癌患者严重发病率较高（P=0.023），临床相关胰瘘（P=0.018）发生率较高。在匹配腺质地和主胰管直径后，远端胆管癌患者仍有较高的临床相关胰瘘（P=0.007）。肿瘤大小＞20mm 预测总生存期（P=0.024）和无病生存期（P=0.003）受损，肿瘤分化（P=0.027）预测总生存期受损。根据肿瘤大小、淋巴结侵犯和切缘匹配患者后，远端胆管癌和胰管腺癌的生存结果相似。胰十二指肠切除术治疗远端胆管癌和胰管腺癌患者的长期结果相似。与胰管腺癌相比，远端胆管癌术后的病程更为复杂。胰十二指肠切除术后，远端胆管癌和胰管腺癌患者的长期肿瘤学结果相似。
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