Delcore R, Rodriguez F J, Forster J, Hermreck A S, Thomas J H
Department of Surgery, University of Kansas Medical Center, Kansas City, USA.
Am J Surg. 1996 Nov;172(5):463-8; discussion 468-9. doi: 10.1016/S0002-9610(96)00237-1.
Recent reports suggest an improved survival following resection for patients with pancreatic carcinoma. However, the prognosis for patients with lymph nodes metastases remains uncertain. The purpose of this study was to determine if the presence of lymph node metastases significantly alters survival in patients with otherwise potentially curable pancreatic carcinoma.
Between 1970 and 1995, 401 patients with pancreatic adenocarcinoma, including 327 patients with pancreatic head tumors, were evaluated and treated.
One hundred (31%) patients underwent pancreatoduodenectomy. Operative mortality was 3% and morbidity was 22%. Median survival for 97 patients discharged from the hospital following resection was 14 months (range 2 to 293). The estimated 1-, 2-, and 5-year survivals were 61%, 43%, and 20%, respectively. Median survival was 11.5 months (range 2 to 87) for patients with positive lymph nodes (n = 56) and 24 (range 0 to 293) months for patients with negative lymph nodes (n = 41; P = 0.0003). Ten patients (10%) survived longer than 5 years, and 9 (90%) of them had negative lymph nodes. Elderly patients (> or = 70 years) had a median survival twice as long as younger patients (24 versus 12 months, P = 0.03).
Lymph node metastases are found in 56% of patients undergoing resection. Pancreatoduodenectomy can be performed with low operative mortality in patients of all ages. It offers good palliation for patients with lymph nodes metastases and encouraging long-term survival rates as well as a chance for cure in patients with negative lymph nodes.
近期报告显示，胰腺癌患者切除术后生存率有所提高。然而，伴有淋巴结转移患者的预后仍不确定。本研究旨在确定淋巴结转移的存在是否会显著改变其他方面可能可治愈的胰腺癌患者的生存率。
1970年至1995年间，对401例胰腺腺癌患者进行了评估和治疗，其中包括327例胰头肿瘤患者。
100例（31%）患者接受了胰十二指肠切除术。手术死亡率为3%，发病率为22%。97例切除术后出院患者的中位生存期为14个月（范围为2至293个月）。估计的1年、2年和5年生存率分别为61%、43%和20%。淋巴结阳性患者（n = 56）的中位生存期为11.5个月（范围为2至87个月），淋巴结阴性患者（n = 41；P = 0.0003）的中位生存期为24个月（范围为0至293个月）。10例（10%）患者存活超过5年，其中9例（90%）淋巴结阴性。老年患者（≥70岁）的中位生存期是年轻患者的两倍（24个月对12个月，P = 0.03）。
在接受切除术的患者中，56%发现有淋巴结转移。所有年龄段的患者均可进行胰十二指肠切除术，手术死亡率较低。该手术可为伴有淋巴结转移的患者提供良好的姑息治疗，具有令人鼓舞的长期生存率，也为淋巴结阴性的患者提供了治愈的机会。
