Baumel H, Huguier M, Manderscheid J C, Fabre J M, Houry S, Fagot H
Department of Digestive Surgery, Hôpital Saint Eloi, Montpellier, France.
Br J Surg. 1994 Jan;81(1):102-7. doi: 10.1002/bjs.1800810138.
A multicentre retrospective study was carried out to analyse short- and long-term results of 787 pancreatic resections performed for cancer between 1982 and 1988. The postoperative mortality rate was 10 per cent and the morbidity rate 35 per cent. Age above 70 years and systemic organ failure independently influenced operative mortality. In patients surviving more than 30 days the median survival was 12.3 months and the actuarial survival rate at 5 years 12 per cent. The 5-year survival rate was lower for patients with lymph node involvement than for those without (4 versus 20 per cent, P = 0.001). The operative mortality rate was higher after total pancreatectomy than pancreatoduodenectomy (17 versus 8 per cent, P = 0.015). The median survival time and 5-year survival rate after total pancreatectomy and pancreatoduodenectomy were 11 versus 14 months and 3 versus 15 per cent respectively. Of the clinical and pathological factors studied, location of the tumour in the left pancreas was most strongly related to survival, with no survivors at 4 years. These results suggest that resection should be avoided in patients over 70 years old with systemic organ failure. Pancreatoduodenectomy remains the best procedure for resection, total pancreatectomy being performed only in patients with multifocal carcinoma or those in whom a safe pancreatic anastomosis cannot be constructed.
开展了一项多中心回顾性研究，以分析1982年至1988年间因癌症进行的787例胰腺切除术的短期和长期结果。术后死亡率为10%，发病率为35%。70岁以上年龄和全身器官衰竭独立影响手术死亡率。存活超过30天的患者中位生存期为12.3个月，5年精算生存率为12%。有淋巴结转移的患者5年生存率低于无淋巴结转移的患者（4%对20%，P = 0.001）。全胰切除术后的手术死亡率高于胰十二指肠切除术（17%对8%，P = 0.015）。全胰切除术和胰十二指肠切除术后的中位生存时间和5年生存率分别为11个月对14个月和3%对15%。在所研究的临床和病理因素中，肿瘤位于胰腺左侧与生存最密切相关，4年时无存活者。这些结果表明，对于有全身器官衰竭的70岁以上患者应避免进行手术切除。胰十二指肠切除术仍然是最佳的切除手术，仅在多灶性癌患者或无法构建安全胰腺吻合的患者中进行全胰切除术。
