Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma.
Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma.
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壶腹癌胰十二指肠切除术后的失败模式。
DOI：
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发表时间：
1993
期刊：
影响因子：
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通讯作者：
C. Compton
中科院分区：
文献类型：
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作者：
C. Willett;A. Warshaw;K. Convery;C. Compton
回顾性分析 41 例壶腹癌患者的临床病程，以确定切除后的失败模式。 29 名仅接受胰十二指肠切除术的患者的五年精算局部控制率和总生存率分别为 69% 和 55%。对于12名具有“低风险”病理特征（肿瘤局限于壶腹部或十二指肠、组织学因素分化良好或中度分化、未受累淋巴结或切除边缘）的患者，五年精算局部控制率和生存率分别为100%和80%。对于这一有利的患者群体来说，辅助治疗可能是不必要的。另一方面，17 名具有“高风险”病理特征（肿瘤侵袭胰腺、组织学低分化、累及淋巴结或切除边缘）的患者在胰十二指肠切除术后五年精算局部控制率和生存率分别仅为 50% 和 38%（p < 0.05）。在 12 名“高危”患者中，他们在胰十二指肠切除术后也接受了术后放射治疗，有更好的局部控制趋势（83%），但生存率没有改善。远处转移（肝脏、腹膜和胸膜）是决定该组结果的主要因素。因此，我们建议进行术前放疗试验，希望通过降低手术切除过程中癌细胞扩散的风险来增强这些结果，特别是在 70% 具有高风险病理特征的患者中。
The clinical courses of 41 patients with ampullary carcinoma were retrospectively reviewed to determine patterns of failure after resection. The five year actuarial local control and overall survival rates of 29 patients undergoing only pancreaticoduodenectomy were 69 and 55 percent, respectively. For 12 patients with "low risk" pathologic features (tumors limited to the ampulla or duodenum, well or moderately well-differentiated histologic factors, uninvolved lymph nodes or resection margins), the five year actuarial local control and survival rate was 100 and 80 percent, respectively. Adjuvant treatment may be unnecessary for this favorable subset of patients. On the other hand, the five year actuarial local control and survival after pancreaticoduodenectomy of 17 patients with "high risk" pathologic features (tumors invasive of the pancreas, poorly differentiated histologic findings, involved lymph nodes or resection margins) was only 50 and 38 percent, respectively (p < 0.05). In 12 patients at "high risk" who also received postoperative radiation therapy after pancreaticoduodenectomy, there was a trend toward better local control (83 percent), but there was no improvement in survival. Distant metastases (liver, peritoneum and pleura) were the dominant factor in determining outcome in this group. Therefore, we propose a trial of preoperative irradiation in hopes of enhancing these outcomes by reducing the risk of dissemination of cancer cells during surgical resection, especially among the 70 percent of patients with high risk pathologic features.