Andersen H B, Baden H, Brahe N E, Burcharth F
Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark.
J Am Coll Surg. 1994 Nov;179(5):545-52.
This study evaluates the indications for and effects of pancreaticoduodenectomy (102 patients) or total pancreatectomy (15 patients) with extensive lymph node dissection performed upon 117 patients for treatment of periampullary adenocarcinoma.
Presenting symptoms and postoperative morbidity and mortality rates were recorded. Cumulative survival rates were evaluated in relation to origin, size, and staging of tumor. Postoperative follow-up of clinical symptoms was done after one year.
The postoperative mortality rate after Whipple's operation was 8 percent (eight patients). The median survival period was 1.1 year and the overall five year survival rate was 15 percent (confidence limits, 5 to 25 percent). The five year survival rate for patients without tumor extension beyond the pancreas was 25 percent (confidence limits, 5 to 50 percent), and in patients with adenocarcinoma of the ampulla of Vater, 34 percent (confidence limits, 3 to 65 percent). The median survival rate in patients with adenocarcinoma of the ampulla of Vater was 3.3 years, which was significantly longer than in the other patients. Fifty-nine patients with distant spread could be divided into 14 patients with para-aortic lymph node metastases who had a significantly shorter survival period than 45 patients without para-aortic lymph node metastases (p = 0.004). Most patients surviving more than one year were doing well, although 60 percent needed exocrine pancreatic substitution therapy.
Resection of periampullary carcinoma provides a better palliation and survival rate than nonoperative biliary drainage or bypass operation. An improved preoperative verification of para-aortic metastases could restrict resection to patients with a prognostic five year survival rate of more than 25 percent and a postoperative mortality rate of less than 5 percent.
本研究评估了117例因壶腹周围腺癌接受胰十二指肠切除术（102例患者）或全胰切除术（15例患者）并广泛清扫淋巴结的手术指征及效果。
记录患者的症状表现、术后发病率及死亡率。根据肿瘤的起源、大小及分期评估累积生存率。术后一年对临床症状进行随访。
Whipple手术后的死亡率为8%（8例患者）。中位生存期为1.1年，总体五年生存率为15%（置信区间为5%至25%）。肿瘤未侵犯胰腺以外区域的患者五年生存率为25%（置信区间为5%至50%），而 Vater壶腹腺癌患者的五年生存率为34%（置信区间为3%至65%）。Vater壶腹腺癌患者的中位生存期为3.3年，显著长于其他患者。59例发生远处转移的患者可分为14例有主动脉旁淋巴结转移的患者和45例无主动脉旁淋巴结转移的患者，前者的生存期明显短于后者（p = 0.004）。大多数存活超过一年的患者情况良好，尽管60%的患者需要胰腺外分泌替代治疗。
与非手术性胆管引流或旁路手术相比，壶腹周围癌切除术能提供更好的缓解效果和生存率。术前对主动脉旁转移进行更准确的评估，可将手术限制在五年生存率预后超过25%且术后死亡率低于5%的患者。
