BACKGROUND:In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL). METHODS:From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery. RESULTS:Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL. CONCLUSIONS:QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated.

译文

背景:在一些中心地区,在某些情况下,姑息性切除术(PR;部分胰十二指肠切除术)优先于晚期胰腺癌的双环旁路手术(DLB)进行推广。这项前瞻性研究将PR与DLB进行了比较,特别关注患者的生活质量(QoL)。
方法:从01/1993年至09/2004年,在前瞻性单中心研究中对姑息性胰腺癌晚期导管腺癌姑息性手术治疗的167例患者进行了分析。 38例接受了PR,129例接受了姑息性DLB。接受DLB的患者分为:(1)局部晚期疾病(LAD-亚组; n = 61; 47%)和(2)转移性疾病(MD-亚组; n = 68; 53%)。使用EORTC QLQ-C30问卷并辅以胰腺癌特定模块评估生活质量。术前和手术后长达12个月收集QoL数据。
结果:PR患者的中位生存期为7.0个月(95%CI 4.09; 9.91),而接受DLB的患者为6.0个月(95%CI 5.39; 6.61)。 PR的死亡率和发病率分别为7.8%和58%,DLB的死亡率为2.6%和42%。 PR后的生活质量比DLB后的生活质量下降更多。 DLB组恢复更快,三个月后达到术前QoL水平,出院时受损程度较小。 LAD子组和MD子组具有相同的QoL水平。
结论:QoL分析显示DLB后有利的QoL数据。此外,两组的生存率没有显着差异,但PR组的发病率和死亡率均升高。因此,需要仔细评估PR在晚期胰腺癌中的应用。

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