Gall F P, Hermanek P, Gebhardt C, Meier H
Leber Magen Darm. 1981 Aug;11(4):179-84.
The prognosis of exocrine carcinoma of the pancreas is still quite bad; because of that, total duodenopancreatectomy following the procedure by Fortner has been our surgical approach since January 1978. Since that time surgery of periampullary carcinoma was extended as well in such a way, that first and second order lymph nodes were excised systematically. Following the introduction of these procedures the percentage of patients with exocrine pancreatic carcinoma operated upon rose from 12 to 35%, - the percentage of patients operated upon because of periampullary carcinoma correspondingly rose from 61 to 91% of all patients carrying these tumors. The incidence of lymphogenous metastases was 88% in 17 patients, which had surgery because of ductal pancreatic carcinoma, and 27% in 22 patients with periampullary carcinoma. 29% of patients with pT1-3 tumors and 71% of patients with pT4 tumors did have already lymphogenous metastases. In 22% of the cases, who would have been operated upon by conventional total duodenopancreatectomy metastases were found in the second order lymph nodes which were taken out according to the new more radical surgical approach; the corresponding figure for patients, who were operated upon by partial duodenopancreatectomy was 5%. Mortality of regional partial duodenopancreatectomy was 4% in our series, and mortality after regional total duodenopancreatectomy was similar to that of conventional pancreatectomy without dissection of lymph nodes.
胰腺外分泌癌的预后仍然相当差；因此，自1978年1月以来，我们一直采用Fortner手术后的全十二指肠胰腺切除术作为手术方法。从那时起，壶腹周围癌的手术范围也得到了扩大，即系统地切除一级和二级淋巴结。采用这些手术方法后，接受手术治疗的胰腺外分泌癌患者比例从12%上升至35%，因壶腹周围癌接受手术治疗的患者比例相应地从所有此类肿瘤患者的61%上升至91%。17例因胰腺导管癌接受手术的患者中，淋巴转移发生率为88%，22例壶腹周围癌患者中为27%。29%的pT1 - 3期肿瘤患者和71%的pT4期肿瘤患者已经发生淋巴转移。在22%按照新的更根治性手术方法切除二级淋巴结的病例中，若采用传统全十二指肠胰腺切除术则会发现转移；接受部分十二指肠胰腺切除术患者的相应比例为5%。在我们的系列研究中，区域性部分十二指肠胰腺切除术的死亡率为4%，区域性全十二指肠胰腺切除术后的死亡率与未进行淋巴结清扫的传统胰腺切除术相似。
