Pedrazzoli S, Sperti C, Pasquali C
Istituto di Semeiotica Chirurgia, Università degli Studi di Padova.
Chir Ital. 1994;46(2):30-8.
Pancreatic cancer has been extensively researched in recent years, but overall survival after diagnosis is almost unchanged since the time of Whipple. In the meantime, we have tried to determine the factors influencing surgical risk, resectability and survival. Between 1968 and 1992, 516 patients with pancreatic cancer were monitored; 160 patients with cancer of the body-tail were excluded. Eighty-five of the remaining 356 patients with pancreatic head cancer were resected, while the remainder underwent only palliative procedures. Surgical outcome, in terms of operative mortality or complications, was correctly predicted preoperatively in > 80% of patients. The preoperative evaluation of the resectability of pancreatic cancer has been investigated with different, mainly invasive, procedures. CT scan, associated with angiography and laparoscopy is reported to give better results, with a resectability rate up to 78%. 67% of our patients who were diagnosed as resectable according to CT-scan features and serum CA 19-9 < 200 U/ml, were actually resected; furthermore 40% had a potentially curative resection. Most of our 'curative' resections (80%) were within this group of patients. Multivariate analysis showed only 4 factors influencing long-term survival: TNM stage, diabetes, age > 70 years, tumour grading.
近年来，胰腺癌受到了广泛研究，但自惠普尔手术时代以来，确诊后的总体生存率几乎没有变化。与此同时，我们试图确定影响手术风险、可切除性和生存率的因素。1968年至1992年间，对516例胰腺癌患者进行了监测；160例胰体尾癌患者被排除。其余356例胰头癌患者中，85例行手术切除，其余仅接受姑息性治疗。在超过80%的患者中，术前正确预测了手术结局，包括手术死亡率或并发症。胰腺癌可切除性的术前评估已通过不同的，主要是侵入性的方法进行了研究。据报道，CT扫描联合血管造影和腹腔镜检查能取得更好的结果，可切除率高达78%。根据CT扫描特征和血清CA 19-9<200 U/ml被诊断为可切除的患者中，67%实际接受了手术切除；此外，40%进行了潜在的根治性切除。我们大多数“根治性”切除（80%）都在这组患者中。多因素分析显示，只有4个因素影响长期生存：TNM分期、糖尿病、年龄>70岁、肿瘤分级。
