Tarazi R Y, Hermann R E, Vogt D P, Hoerr S O, Esselstyn C B, Cooperman A M, Steiger E, Grundfest S
Surgery. 1986 Oct;100(4):716-23.
Data on 126 consecutive patients with periampullary tumors resected at the Cleveland Clinic between January 1950 and December 1984 were reviewed. One hundred five patients underwent pancreatoduodenal resection, 10 patients total pancreatectomy, and 11 patients local resection of the tumor. The site of tumor was ampulla of Vater (59), head of the pancreas (30), duodenum (20), and distal common bile duct (11). Six patients had benign disease. The operative mortality rate for radical resection for the entire period was 7.8%; it has declined to 5.4% since 1974. The operative mortality rate for local resection was 9.1% (one patient). The overall 5-year survival rate for all malignant tumors of the periampullary area was 28% and 25.5% for invasive adenocarcinoma. Survival was affected primarily by location and histologic findings. The 5-year survival rate for adenocarcinoma of the ampulla of Vater was 37.2%, 27.5% for the duodenum, 16.7% for the distal common bile, and 4.3% for the pancreas (p = 0.0001). Papillary adenocarcinoma had a 5-year survival rate of 49.2% in contrast to 18.4% for nonpapillary ductal adenocarcinoma (p = 0.002). Patients with ampullary adenocarcinoma treated by local resection had a 5-year survival rate of 40.9%. These data justify continued use of a selective radical approach in the resection of most periampullary tumors with local resection for small tumors in high-risk patients.
回顾了1950年1月至1984年12月在克利夫兰诊所接受壶腹周围肿瘤切除术的126例连续患者的数据。105例患者接受了胰十二指肠切除术，10例患者接受了全胰切除术，11例患者接受了肿瘤局部切除术。肿瘤部位为 Vater壶腹（59例）、胰头（30例）、十二指肠（20例）和胆总管远端（11例）。6例患者患有良性疾病。整个时期根治性切除的手术死亡率为7.8%；自1974年以来已降至5.4%。局部切除的手术死亡率为9.1%（1例患者）。壶腹周围区域所有恶性肿瘤的总体5年生存率为28%，浸润性腺癌为25.5%。生存主要受肿瘤位置和组织学结果影响。Vater壶腹腺癌的5年生存率为37.2%，十二指肠为27.5%，胆总管远端为16.7%，胰腺为4.3%（p = 0.0001）。乳头状腺癌的5年生存率为49.2%，而非乳头状导管腺癌为18.4%（p = 0.002）。接受局部切除治疗的壶腹腺癌患者的5年生存率为40.9%。这些数据证明在大多数壶腹周围肿瘤的切除中继续采用选择性根治性方法并对高危患者的小肿瘤进行局部切除是合理的。
