Forrest J F, Longmire W P
Ann Surg. 1979 Feb;189(2):129-38. doi: 10.1097/00000658-197902000-00001.
Over a 21 year period, 245 cases of cancer of the pancreas were operated upon and followed-up at UCLA Hospital. A further 34 cases of periampullary tumor were treated by partial or total pancreatectomy. Apparent clearance of tumors at the time of pancreaticoduodenectomy that was confirmed by subsequent histopathology resulted in a patient survival time of 20.3 months as compared with a figure of 12.9 months when the pathological examination revealed tumor in a resection margin, although the surgeon believed that excision had been complete at the time of operation. Frozen section examination of resection margins is therefore mandatory. The result of performing a pancreaticoduodenectomy in which tumor was seen to be left behind was a survival time of only 6.8 months, which is similar to the survival time of 6.2 months following a palliative biliary bypass. Pancreaticoduodenectomy in patients over the age of 70 resulted in an average survival of only 7.6 months. Of patients having a palliative biliary bypass alone, 13% required subsequent reoperation to bypass distressing duodenal obstruction. A duodenal bypass should therefore be a routine concomitant of a biliary bypass. Total pancreatectomy with duodenectomy for pancreatic cancer gave an increased average survival of 26 months, and it is likely that the frequency of performance of this operation will increase.
在21年的时间里，加州大学洛杉矶分校医院对245例胰腺癌患者进行了手术并进行随访。另外34例壶腹周围肿瘤患者接受了部分或全胰切除术治疗。胰十二指肠切除术中肿瘤的明显清除经后续组织病理学证实，患者的生存时间为20.3个月，而当病理检查显示切除边缘有肿瘤时，生存时间为12.9个月，尽管外科医生认为手术时切除是完整的。因此，切除边缘的冰冻切片检查是必不可少的。在胰十二指肠切除术中发现有肿瘤残留的患者，其生存时间仅为6.8个月，这与姑息性胆肠吻合术后6.2个月的生存时间相似。70岁以上患者行胰十二指肠切除术的平均生存期仅为7.6个月。仅行姑息性胆肠吻合术的患者中，13%需要随后再次手术以解除令人痛苦的十二指肠梗阻。因此，十二指肠旁路手术应作为胆肠吻合术的常规伴随手术。胰腺癌行全胰十二指肠切除术使平均生存期延长至26个月，而且这种手术的实施频率可能会增加。
