保留幽门与标准胰十二指肠切除术对胰头导管腺癌预后的影响

Prognosis of patients with pancreatic head ductal adenocarcinoma undergoing pylorus-preserving versus standard pancreaticoduodenectomy

目的探讨保留幽门胰十二指肠切除术(PPPD)与标准胰十二指肠切除术(SPD)对胰头导管腺癌预后的影响。方法提取监测、流行病学和结果(SEER)数据库2004至2009年行胰十二指肠切除术且病理证实为胰头导管腺癌的3 251例患者的临床资料,其中PPPD 446例,SPD 2 805例。比较PPPD与SPD患者的预后情况。结果 PPPD与SPD患者在性别、年龄、种族、分化程度、肿瘤大小、侵袭范围、阳性淋巴结数、淋巴结检出数、TNM分期、30d病死率等方面比较,差异均无统计学意义(均P>0.05)。3 251例患者总体1、3、5年生存率分别为0.67、0.24和0.14,生存期为18.8(35.0,10.0)个月。PPPD患者1、3、5年生存率分别为0.69、0.26和0.16,生存期为19.5(37.0,10.0)个月;SPD患者1、3、5年生存率分别为0.67、0.23和0.14,生存期为18.7(35.0,10.0)个月。PPPD与SPD患者的累积生存率比较,差异无统计学意义(P>0.05)。经Cox比例风险模型分析,性别、年龄、分化程度、肿瘤大小、侵袭范围、阳性淋巴结数、淋巴结检出数、TNM分期均是胰头导管腺癌术后预后的独立影响因素(均P<0.05),而手术方式、种族与预后无关(P>0.05)。在性别、年龄、分化程度、肿瘤大小、阳性淋巴结数、淋巴结检出数、TNM分期的亚组中,PPPD组与SPD组生存期比较,差异均无统计学意义(均P>0.05);在侵袭范围的亚组中,当有远处侵犯或转移时,PPPD组生存期长于SPD组(P<0.05)。结论 PPPD手术切除范围较小,其总体生存率与SPD相似;当有远处侵犯及转移时,行PPPD的患者生存期长于行SPD的患者。

Objective To compare the prognosis of patients with pancreatic head ductal adenocarcinoma undergoing pylorus-preserving pancreaticoduodenectomy(PPPD)versus standard pancreaticoduodenectomy(SPD).Methods Data were extracted fromthe Surveillance,Epidemiology,and End Results(SEER)database;total 3251 patients with pancreatic head ductal adenocarcinoma from 2004 to 2009 were involved,including 446 underwent PPPD and 2805 cases underwent SPD.The effect of PPPD and SPD on the prognosis of patients was analyzed.Results There were no statistical differences in sex,age,race,pathological grading,tumor size,range of invasion,number of positive lymph nodes and number of lymph nodes examined,TNM staging,and 30-day mortality rate between the PPPD and SPD groups(P<0.05).The 1-,3-and 5-year survival rates of patients were 0.67,0.24 and 0.14,respectively with a median survival time of 18.8(35.0,10.0)months.The 1-,3-and 5-year survival rates of PPPD group were 0.69,0.26 and 0.16,respectively with a median survival time of 19.5(37.0,10.0)months,those of SPD group were 0.67,0.23 and 0.14 with a median survival time of 18.7(35.0,10.0)months,there were no significant differences between two groups(P>0.05).The Cox proportional risk model demonstrated that gender,age,pathological grading,tumor size,range of invasion,lymph nodes positive,lymph nodes examined,and TNM staging were the independent prognostic factors for patient with pancreatic head ductal adenocarcinoma after surgery(P<0.05),but the operative modalities or race were not correlated with the prognosis(P>0.05).In the subgroups of gender,age,pathological grading,tumor size,number of lymph nodes positive,number of lymph nodes examined,and TNM staging,there was no significant difference between group PPPD and group SPD(P>0.05),but when the distant invasion or metastasis occurred,the median survival time of group PPPD was longer than that of group SPD(P<0.05).Conclusion The resected extent of PPPD is lesser,and the overall survival rate is similar to that of SPD.When distant invasion or metastasis occurring,the survival time of patients with PPPD is longer than that of patients with SPD.