Hong Seung-Soo, Han Sung-Sik, Kwon Wooil, Jang Jin-Young, Kim Hee-Joon, Cho Chol-Kyoon, Ahn Keun-Soo, Yang Jae-Do, Park Youngmok, Min Seog-Ki, Moon Ju-Ik, Roh Young-Hoon, Lee Seung-Eun, Park Joon-Seong, Kim Sang-Geol, Jeong Chi-Young, Heo Jin-Seok, Hwang Ho-Kyoung
Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Surgery, National Cancer Center, Goyang 10408, Korea.
Cancers (Basel). 2021 Apr 23;13(9):2038. doi: 10.3390/cancers13092038.
This study used multicenter data to compare the oncological safety of transduodenal ampullectomy (TDA) with that of pylorus-preserving pancreatoduodenectomy (PPPD) in early ampulla of Vater (AoV) cancer. Data for patients who underwent surgical resection for AoV cancer (pTis-T2 stage) from January 2000 to September 2019 were collected from 15 institutions. The clinicopathologic characteristics and survival outcomes were compared between the PPPD and TDA groups. A total of 486 patients were enrolled (PPPD, 418; TDA, 68). The oncologic behavior in the PPPD group was more aggressive than that in the TDA group at all T stages: larger tumor size ( = 0.034), advanced T stage ( < 0.001), aggressive cell differentiation ( < 0.001), and more lymphovascular invasion ( = 0.002). Five-year disease-free survival (DFS) and overall survival (OS) did not differ between the two groups when considering all T stages or only the Tis+T1 group. Among T1 patients, PPPD produced significantly better DFS (PPPD vs. TDA, 84.8% vs. 66.6%, = 0.040) and superior OS (PPPD vs. TDA, 89.1% vs. 68.0%, = 0.056) than TDA. Lymph node dissection (LND) in the TDA group did not affect DFS or OS (TDA + LND vs. TDA-only, DFS, = 0.784; OS, = 0.870). In conclusion, PPPD should be the standard procedure for early AoV cancer.
本研究采用多中心数据，比较十二指肠壶腹切除术（TDA）与保留幽门的胰十二指肠切除术（PPPD）在早期 Vater 壶腹（AoV）癌中的肿瘤学安全性。收集了 2000 年 1 月至 2019 年 9 月期间因 AoV 癌（pTis-T2 期）接受手术切除患者的数据，这些数据来自 15 家机构。比较了 PPPD 组和 TDA 组的临床病理特征及生存结局。共纳入 486 例患者（PPPD 组 418 例；TDA 组 68 例）。在所有 T 分期中，PPPD 组的肿瘤学行为均比 TDA 组更具侵袭性：肿瘤更大（P = 0.034）、T 分期更高（P < 0.001）、细胞分化更具侵袭性（P < 0.001）以及更多的淋巴管侵犯（P = 0.002）。考虑所有 T 分期或仅 Tis+T1 组时，两组的 5 年无病生存率（DFS）和总生存率（OS）无差异。在 T1 期患者中，PPPD 的 DFS 显著优于 TDA（PPPD 组 vs. TDA 组，84.8% vs. 66.6%，P = 0.040），OS 也优于 TDA（PPPD 组 vs. TDA 组，89.1% vs. 68.0%，P = 0.056）。TDA 组的淋巴结清扫（LND）对 DFS 或 OS 无影响（TDA + LND 组 vs. 仅 TDA 组，DFS，P = 0.784；OS，P = 0.870）。总之，PPPD 应作为早期 AoV 癌的标准术式。
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