Tryka A F, Brooks J R
Ann Surg. 1979 Sep;190(3):373-81. doi: 10.1097/00000658-197909000-00013.
Whipple resections for pancreatic head carcinoma are often inadequate because tumor is left behind in the body and tail. Thirty-six patients have undergone total pancreatectomy for various conditions, of which 25 have undergone total pancreatectomy, for ductal carcinoma. Thirty-seven per cent of these 25 patients have shown histologic evidence that a Whipple resection would not have adequately removed tumor-bearing pancreatic tissue. Three patients had carcinoma spreading up and along the common bile duct from a primary ductal carcinoma in the head of the pancreas. Four patients had tumor infiltrating in continuity into the pancreatic body and tail at a distance from the palpable tumore in the head well to the left of a Whipple transection site. Five patients had widespread multifocal autonomous tumor involving other areas in the gland but with tumor palpable only in the head of the pancreas. Three patients (12%) died postoperatively. The two year survival rate is 32%, and the five year survival, 19%. Histological factors affecting the survival prognosis include 1) positive nodes, 2) tumor extension up the common duct, and 3) intrapancreatic extension and multicentricity of tumor mandating total pancreatectomy for hope of cure in at least 38% of cases.
因胰头癌行胰十二指肠切除术时，由于胰体尾仍残留肿瘤，手术往往不彻底。36例患者因各种病症接受了全胰切除术，其中25例因导管癌接受了全胰切除术。这25例患者中有37%的组织学证据表明，胰十二指肠切除术无法充分切除含肿瘤的胰腺组织。3例患者的癌肿从胰头的原发性导管癌向上并沿胆总管扩散。4例患者的肿瘤在距胰头可触及肿瘤一定距离处连续浸润至胰体和胰尾，远在胰十二指肠横断部位左侧。5例患者有广泛的多灶性自主性肿瘤累及腺体其他部位，但仅在胰头可触及肿瘤。3例患者（12%）术后死亡。两年生存率为32%，五年生存率为19%。影响生存预后的组织学因素包括：1）淋巴结阳性；2）肿瘤沿胆总管向上扩展；3）肿瘤在胰腺内扩展及多中心性，至少38%的病例因这些因素需要行全胰切除术以获治愈希望。
