Mosca F, Giulianotti P C, Balestracci T, Boggi U, Giardino D, Di Candio G, Rossi G, Fornaciari G
Istituto di Chirurgia Generale e Sperimentale, Università degli Studi, Pisa.
Chir Ital. 1994;46(2):59-67.
The aim of this retrospective study is to evaluate whether the pylorus preserving pancreatoduodenectomy (PPPD) is as safe as the standard Whipple's procedure (PD) in the treatment of pancreatic and periampullary cancer. Between January 1980 and December 1993, 473 patients with carcinoma of the head of the pancreas or periampullary region were admitted to the Department of General Surgery of Pisa University Hospital. 201 of these patients underwent pancreatoduodenectomy (115 ductal carcinoma, 61 periampullary cancer, 25 other neoplasms). In each group patients received a PPPD or a PD (ductal carcinoma 76 PPPD and 33 PD; periampullary cancer 46 PPPD and 15 PD). Overall, postoperative mortality rate for PPPD was 7.5% and for PD 8.9%, decreasing in the last 6 years to 3.2% (3 out of 92 consecutive cases). Variables examined were age, sex, T and N status, tumour stage, histological grade, residual tumour, cancer recurrence, death from recurrence and survival time. No patient was treated with antiblastic therapy. Survival times were estimated for both PPPD and PD using the Kaplan-Meier method and thereafter compared with each other using the Breslow and Mantel-Cox test. The 5-year survival rate in PPPD was 12.3% and 63.01% for ductal and periampullary carcinoma respectively. Survival time was not statistically different between PPPD and PD for both ductal and periampullary cancer. As regards pancreatic cancer, the presence of lymph node metastasis appeared to be a poor prognostic factor, even though it did not reach statistical significance (p = 0.075). In conclusion PPPD may be considered a valid surgical option even when dealing with pancreatic or periampullary cancer.
本回顾性研究的目的是评估保留幽门的胰十二指肠切除术（PPPD）在治疗胰腺和壶腹周围癌方面是否与标准的惠普尔手术（PD）一样安全。1980年1月至1993年12月期间，473例胰腺头部或壶腹周围区域癌患者入住比萨大学医院普通外科。其中201例患者接受了胰十二指肠切除术（115例导管癌，61例壶腹周围癌，25例其他肿瘤）。每组患者接受PPPD或PD（导管癌76例接受PPPD，33例接受PD；壶腹周围癌46例接受PPPD，15例接受PD）。总体而言，PPPD的术后死亡率为7.5%，PD为8.9%，在过去6年中降至3.2%（92例连续病例中有3例）。检查的变量包括年龄、性别、T和N状态、肿瘤分期、组织学分级、残留肿瘤、癌症复发、复发死亡和生存时间。所有患者均未接受抗瘤治疗。使用Kaplan-Meier方法估计PPPD和PD的生存时间，然后使用Breslow和Mantel-Cox检验进行相互比较。PPPD中导管癌和壶腹周围癌的5年生存率分别为12.3%和63.01%。导管癌和壶腹周围癌的PPPD和PD生存时间在统计学上无差异。对于胰腺癌，淋巴结转移的存在似乎是一个不良预后因素，尽管未达到统计学意义（p = 0.075）。总之，即使在处理胰腺或壶腹周围癌时，PPPD也可被视为一种有效的手术选择。
