Increased Rates of Duodenal Obstruction in Pancreatic Cancer Patients Receiving Modern Medical Management
Increased Rates of Duodenal Obstruction in Pancreatic Cancer Patients Receiving Modern Medical Management
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DOI：
10.1007/s10620-014-3170-y
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发表时间：
2014-09-01
影响因子：
3.1
通讯作者：
Savides, Thomas J.
中科院分区：
文献类型：
--
作者：
Shah, Ashish;Fehmi, Abbas;Savides, Thomas J.
胰腺癌引起的十二指肠梗阻历史上发生在2- 25%的未手术患者中，但随着化疗和放疗的新进展，胰腺癌的预期寿命增加了。该研究的目的是确定未接受手术切除的胰头癌患者发生需要干预的十二指肠梗阻的发生率，但接受现代化放疗。这是一项回顾性单中心研究。入选标准为胰腺癌患者，他们接受了ERCP和金属胆道支架，然后进行了放化疗，随后发生了症状性十二指肠梗阻，并接受了金属十二指肠支架置入术或外科十二指肠旁路术。（38%，接受化疗和/或放疗的不可切除胰腺癌和胆道支架患者发生十二指肠梗阻。从胰腺癌诊断到发生出口梗阻的平均时间为11.4 +/- A 4.9个月（范围1.5-40个月）。从发生十二指肠梗阻到死亡的平均时间为4.8 ± 2.1个月（范围0.5-60个月）。从诊断到死亡的平均生存时间为16.6 +/-A5.6个月（范围4.5-58个月）。接受化疗和/或放疗的不可切除的胰头癌和金属胆道支架的患者中有38%最终发展为症状性十二指肠梗阻，需要十二指肠支架或手术旁路。这一十二指肠梗阻的发生率几乎是以前使用旧肿瘤治疗的报告的两倍，并且随着胰腺癌药物治疗的进展，患者生存时间的延长可能会增加。
Duodenal obstruction from pancreatic cancer historically occurs in 2-25 % of patients without surgery, but with new advances in chemotherapy and radiation therapy, the life expectancy of pancreatic cancer has increased.The aim of the study was to determine the rate of development of duodenal obstruction requiring intervention in patients with pancreatic head adenocarcinoma who do not undergo surgical resection, but receive modern chemoradiation.It is a retrospective single center study. Inclusion criteria were patients with pancreatic cancer who underwent ERCP with metal biliary stent and then chemoradiation who subsequently developed symptomatic duodenal obstruction and underwent either metal duodenal stent placement or surgical duodenal bypass.Twenty-four of 63 patients (38 %, 95 % CI 26-50 %) with unresectable pancreatic cancer and biliary stents who received chemotherapy and/or radiation therapy developed duodenal obstruction. The average length of time from diagnosis of pancreatic adenocarcinoma to development of outlet obstruction was 11.4 +/- A 4.9 months (range 1.5-40 months). Average length of time from development of duodenal obstruction to death was 4.8 +/- A 2.1 months (range 0.5-60 months). Average survival time from diagnosis to death was 16.6 +/- A 5.6 months (range 4.5-58 months).Thirty-eight percent of patients with unresectable pancreatic head adenocarcinoma and metal biliary stents who receive chemotherapy and/or radiation therapy eventually develop symptomatic duodenal obstruction requiring duodenal stent or surgical bypass. This rate of duodenal obstruction is nearly twice that of previous reports using older oncologic therapy and will likely increase as patients survive longer with advances in medical therapy for pancreatic cancer.