Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
Department of Bun, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
Surg Endosc. 2023 Jan;37(1):109-119. doi: 10.1007/s00464-022-09441-1. Epub 2022 Jul 18.
Pancreatoduodenectomy (PD) and total pancreatectomy (TP) are two surgical methods to treat patients with pancreatic head adenocarcinoma (PHAC). However, the oncologic outcomes of TP for PHAC remain controversial. In this study, we compared early mortality and long-term survival patients undergoing TP and those with PD.
All patients diagnosed with non-metastatic PHAC who underwent PD or TP from 1988 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to balance the inter-group covariates. Cancer-specific survival (CSS) was the primary endpoint.
A total of 4748 patients (743 TP and 4005 PD) were included in the study. Some 740 patients who underwent TP were matched with 1479 who had PD. After PSM, there was no difference between TP and PD groups regarding 30-day mortality (3.5% vs. 2.7%, p = 0.290) and 90-day mortality (9.9% vs. 8%, p = 0.135). More importantly, TP showed comparable survival in comparison to PD, prior or after excluding patients who died within 30 and 90 days. Besides, multivariate analysis revealed that tumor size, tumor stage, N stage, chemotherapy, and radiation were significant prognostic factors.
PD and TP have similar early mortality and long-term survival for patients with PHAC. In selected patients, TP can be used when oncologically appropriate.
胰十二指肠切除术（PD）和全胰切除术（TP）是两种治疗胰头腺癌（PHAC）患者的手术方法。然而，TP 治疗 PHAC 的肿瘤学结果仍存在争议。在本研究中，我们比较了接受 TP 和 PD 的患者的早期死亡率和长期生存情况。
从 1988 年至 2016 年，从监测、流行病学和最终结果数据库中检索出所有诊断为非转移性 PHAC 且接受 PD 或 TP 的患者。采用倾向评分匹配（PSM）来平衡组间协变量。癌症特异性生存率（CSS）是主要终点。
共纳入 4748 例患者（743 例 TP 和 4005 例 PD）。740 例行 TP 的患者与 1479 例行 PD 的患者进行了匹配。PSM 后，TP 组和 PD 组 30 天死亡率（3.5%比 2.7%，p=0.290）和 90 天死亡率（9.9%比 8%，p=0.135）无差异。更重要的是，TP 的生存情况与 PD 相当，无论是在排除 30 天和 90 天内死亡的患者之前还是之后。此外，多变量分析显示，肿瘤大小、肿瘤分期、N 分期、化疗和放疗是显著的预后因素。
PD 和 TP 治疗 PHAC 患者的早期死亡率和长期生存相似。在选择合适的患者时，可以使用 TP。
