Mosca F, Giulianotti P C, Balestracci T, Di Candio G, Pietrabissa A, Sbrana F, Rossi G
Istituto di Chirurgia Generale e Sperimentale, U.O. di Chirurgia Generale e Vascolare, Università di Pisa, Italy.
Surgery. 1997 Sep;122(3):553-66. doi: 10.1016/s0039-6060(97)90128-8.
This study compared long-term survival in pancreatic or periampullary cancer treated with Whipple pancreatoduodenectomy (PD) and pylorus-preserving pancreatoduodenectomy (PPPD).
Two hundred twenty-one patients with pancreatic head or periampullary cancer were treated. Prognostic variables included age, gender, type and period of operation, and tumor stage. In the ductal adenocarcinomas variables also included tumor and node status, type of lymphadenectomy, pathologic grade, and presence of microscopic residual tumor. The end point was death as a result of neoplastic recurrence. Survival curves were estimated by using the Kaplan-Meier method, and multifactorial analysis was also performed on the data from the ductal adenocarcinoma group.
The mortality rate was 8.2% in the PD group versus 7.0% in the PPPD group. Morbidity rates were 34.4% for PD and 45.8% for PPPD. Five-year survival was 9.6% in the ductal adenocarcinoma and 63.8% in the periampullary carcinoma groups. Univariate analysis failed to show statistically significant differences in survival curves between the two treatments in either patient group. Correcting for multiple variables in the ductal adenocarcinoma group did not reveal any significant differences in survival rates between the two treatments.
PPPD was as successful as classic PD in the treatment of ductal adenocarcinoma and periampullary cancer of the pancreas. Long-term survival was not influenced by the type of resection.
本研究比较了接受惠普尔胰十二指肠切除术（PD）和保留幽门胰十二指肠切除术（PPPD）治疗的胰腺癌或壶腹周围癌患者的长期生存率。
对221例胰头或壶腹周围癌患者进行了治疗。预后变量包括年龄、性别、手术类型和时期以及肿瘤分期。在导管腺癌中，变量还包括肿瘤和淋巴结状态、淋巴结清扫类型、病理分级以及微小残留肿瘤的存在情况。终点为肿瘤复发导致的死亡。采用Kaplan-Meier方法估计生存曲线，并对导管腺癌组的数据进行多因素分析。
PD组死亡率为8.2%，PPPD组为7.0%。PD组的发病率为34.4%，PPPD组为45.8%。导管腺癌组的5年生存率为9.6%，壶腹周围癌组为63.8%。单因素分析未显示两组患者中两种治疗方法的生存曲线存在统计学显著差异。对导管腺癌组的多个变量进行校正后，未发现两种治疗方法的生存率存在任何显著差异。
在治疗胰腺导管腺癌和壶腹周围癌方面，PPPD与经典PD同样成功。长期生存率不受切除类型的影响。
