Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea.
BMC Surg. 2022 Jul 4;22(1):258. doi: 10.1186/s12893-022-01649-1.
Distal common bile duct (dCBD) cancer is typical indication for pancreaticoduodenectomy (PD). We aimed to retrospectively evaluate surgical outcomes and investigate prognostic factors of dCBD adenocarcinoma for which PD was performed at a single institution.
We searched consecutive cases of dCBD adenocarcinoma undergone PD at Samsung Medical Center from 1995 to 2018. Cases with distant metastasis or palliative intent were excluded. The year in which the survival rate was dramatically improved was identified and entire years were divided into two periods for comparison. To balance between the two periods, we conducted propensity score matching (PSM) analysis using age, sex, body mass index (BMI), and American Society of Anesthesiologist score.
Total of 804 cases were enrolled in this study. The entire period was divided into early period of 18 years and recent period of 6 years. The early and late period included 466 and 338 patients, respectively. As a result of PSM, balanced 316 patients were selected from each of the two periods. Significant improvements in surgical outcomes were identified, including shorter operation time, fewer blood loss, shorter hospitalization, and favorable overall survival. As results of multivariable analysis of independent risk factors for overall survival, older age and advanced N stage were identified, as expected. It was distinct that aggressive surgery and advanced tumor state in the early period and a lower BMI in the late period negatively affected the survival, respectively.
Surgical outcomes of dCBD cancer underwent PD was improved. There were few modifiable factors to improve survival and continuous further study is needed to detect dCBD cancer in the early stages.
远端胆总管（dCBD）癌是胰十二指肠切除术（PD）的典型适应证。我们旨在回顾性评估在一家医院行 PD 治疗的 dCBD 腺癌的手术结果，并探讨其预后因素。
我们检索了 1995 年至 2018 年期间在三星医疗中心接受 PD 治疗的 dCBD 腺癌连续病例。排除有远处转移或姑息性治疗意图的病例。确定生存率显著提高的年份，并将整个年份分为两个时期进行比较。为了在两个时期之间平衡，我们使用年龄、性别、体重指数（BMI）和美国麻醉医师协会评分进行倾向评分匹配（PSM）分析。
本研究共纳入 804 例患者。整个时期分为 18 年的早期和 6 年的近期。早期和晚期分别包括 466 例和 338 例患者。通过 PSM，从两个时期中各选择了 316 例平衡的患者。手术结果明显改善，包括手术时间缩短、出血量减少、住院时间缩短和总体生存率提高。多变量分析显示，年龄较大和 N 分期较晚是总体生存率的独立危险因素，这是意料之中的。在早期，积极的手术和晚期肿瘤状态以及较低的 BMI 分别对生存产生负面影响，这一点很明显。
行 PD 治疗的 dCBD 癌的手术结果得到了改善。有几个可改变的因素可以提高生存率，需要进一步研究以早期发现 dCBD 癌。
