Sexe R B, Wade T P, Virgo K S, Johnson F E
Department of Surgery, John Cochran VA Medical Center, St. Louis, Missouri, USA.
Cancer. 1996 Jan 15;77(2):251-4. doi: 10.1002/(SICI)1097-0142(19960115)77:2<251::AID-CNCR5>3.0.CO;2-P.
Because fewer than 1000 cases of primary adenocarcinoma of the duodenum have been reported, earlier series are limited by local referral patterns and the long periods of time needed for retrospective reviews.
This study reports the outcomes of preiampullary duodenal adenocarcinoma treatments in all hospitals of the Department of Veterans Affairs from 1987 through 1991, using computer and tumor registry records. Patients were grouped by their most aggressive treatment (resection > operative bypass > percutaneous biliary intubation) and survival calculated from the date of this procedure.
Of 2185 patients with periampullary cancers (1753 pancreatic, 432 other periampullary), 85 were duodenal and thus comprised only 4% of periampullary tumors. Thirty-four duodenal cancers were resected, 44 bypassed, and 7 had biliary intubation, with 30-day mortality rates of 6%, 18%, and 0%, respectively. Mean survival exceeded 1 year in all groups, and resection resulted in a significant increase in mean survival (784 vs. 438 days for nonresection, P = 0.01). The projected 5-year survival rate after resection was 23%. Mean survival after resection of 9 Stage I-II cancers was 668 days, but was similar after 5 resections with nodal or other metastases. Similarly, survival did not correlate with cancer stage in 13 palliated patients.
This large study of patients with duodenal cancer provides a unique perspective of disease prevalence and response to surgical treatment. Prolonged survival is common with any treatment, but the longest survivals were after resection.
由于原发性十二指肠腺癌的报告病例不足1000例，早期系列研究受到当地转诊模式以及回顾性研究所需长时间的限制。
本研究利用计算机和肿瘤登记记录，报告了1987年至1991年退伍军人事务部所有医院壶腹周围十二指肠腺癌的治疗结果。患者按其最积极的治疗方式分组（切除>手术旁路>经皮胆道插管），并从该手术日期计算生存率。
在2185例壶腹周围癌患者（1753例胰腺癌，432例其他壶腹周围癌）中，85例为十二指肠癌，仅占壶腹周围肿瘤的4%。34例十二指肠癌接受了切除，44例进行了旁路手术，7例进行了胆道插管，30天死亡率分别为6%、18%和0%。所有组的平均生存期均超过1年，切除导致平均生存期显著增加（未切除组为438天，切除组为784天，P = 0.01）。切除术后预计的5年生存率为23%。9例I-II期癌症切除后的平均生存期为668天，但5例有淋巴结或其他转移的切除术后生存期相似。同样，13例姑息治疗患者的生存期与癌症分期无关。
这项对十二指肠癌患者的大型研究提供了疾病患病率和手术治疗反应的独特视角。任何治疗方法都常有生存期延长的情况，但生存期最长的是切除术后。
