Variations in surgical treatment and outcomes of patients with pancreatic cancer: A population-based study
Variations in surgical treatment and outcomes of patients with pancreatic cancer: A population-based study
复制标题
DOI：
10.1245/s10434-007-9601-7
复制
发表时间：
2008-01-01
影响因子：
3.7
通讯作者：
Law, Calvin H. L.
中科院分区：
文献类型：
--
作者：
Govindarajan, Anand;Tan, Jensen C. C.;Law, Calvin H. L.
背景：关于手术技术的变化如何影响胰腺癌的预后一直存在争议。这项以人群为基础的研究探讨了目前的手术实践和结果的胰腺癌head.Methods：所有患者18至85岁诊断为非转移性腺癌的胰头从1998年至2003年确定的监测，流行病学和最终结果（SEER）计划注册。使用多变量回归来阐明与所进行的胰十二指肠切除术类型、淋巴结（LN）评估范围、早期死亡率和晚期生存率相关的因素。结果：总体而言，2111名患者纳入研究，其中83.7%接受了标准治疗。维普莱胰十二指肠切除术（PD）。然而，保留幽门的胰腺切除术（PPPD;范围，0.03%-32.0%; P <0.0001）和全胰腺切除术（TP;范围，0.04%-19.5%; P <0.0001）的使用存在明显的区域差异。TP与早期死亡率显著升高相关（比值比，2.6; 95%可信区间，1.6 - 4.1; P <0.0001），但TP、PPPD和PD之间的晚期生存率无显著差异（P = 0.69）。在评估的LN数量中也观察到显著变化（SEER区域范围，7.3-13.5; P <0.0001）。LN评估降低诊断为节点阳性的患者的几率，并与更糟糕的晚期survival.Conclusions：在这项以人群为基础的研究中，我们发现显着的临床重要的变异性，在手术治疗的胰头癌，相对于使用TP，PPPD，或PD，LN评估的程度。进一步的研究是必要的，以阐明潜在的原因，并阐明充分的淋巴结切除术的作用。
Background: There is ongoing debate on how variations in surgical technique affect outcomes in pancreatic cancer. This population-based study examines current surgical practice and outcomes for cancer of the pancreatic head.Methods: All patients 18 to 85 years old diagnosed with nonmetastatic adenocarcinoma of the pancreatic head from 1998 through 2003 were identified from the Surveillance, Epidemiology and End Results (SEER) Program registry. Multivariable regression was used to elucidate factors associated with the type of pancreaticoduodenectomy performed, extent of lymph node (LN) assessment, early mortality, and late survival.Results: Overall, 2111 patients were included in the study, with 83.7% treated with a standard Whipple pancreaticoduodenectomy (PD). However, there was marked regional variation in the use of pylorus-preserving pancreaticoduodenectomy (PPPD; range, .03%-32.0%; P < .0001) and total pancreatectomy (TP; range, .04%-19.5%; P < .0001). TP was associated with significantly higher early mortality (odds ratio, 2.6; 95% confidence interval, 1.6 to 4.1; P < .0001), but late survival did not differ significantly between TP, PPPD, and PD (P = .69). Significant variation was also seen in the number of LN assessed (range across SEER regions, 7.3-13.5; P < .0001). Decreased LN assessment reduced the odds of diagnosing a patient as node positive and was associated with worse late survival.Conclusions: In this population-based study, we found marked clinically important variability in the surgical treatment of adenocarcinoma of the pancreatic head, with respect to the use of TP, PPPD, or PD, and the extent of LN assessment. Further research is warranted to elucidate the underlying reasons, and to clarify the role of adequate lymphadenectomy.