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Inicio Cirugía Española (English Edition) Surgical treatment of pancreatic adenocarcinoma using cephalic duodenopancreatec...
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Vol. 88. Núm. 6.
Páginas 374-382 (diciembre 2010)
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Vol. 88. Núm. 6.
Páginas 374-382 (diciembre 2010)
Original article
Acceso a texto completo
Surgical treatment of pancreatic adenocarcinoma using cephalic duodenopancreatectomy (Part 2). Long term follow up after 204 cases
Tratamiento quirúrgico del adenocarcinoma pancreático mediante duodenopancreatectomía cefálica (parte 2). Seguimiento a largo plazo tras 204 casos
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Juan Fabregata, Juli Busquetsa,
Autor para correspondencia
jbusquets@bellvitgehospital.cat

Corresponding author.
, Núria Peláeza, Rosa Jorbaa, Francisco García-Borobiaa, Cristina Masuetb, Carlos Vallsc, Sandra Ruiz-Osunac, Teresa Serranod, Maica Galáne, María Cambrayf, Berta Laquentee, Emilio Ramosa, Antoni Rafecasa
a Servicio de Cirugía General y Digestiva, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
b Servicio de Medicina Preventiva, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
c Servicio Radiodiagnóstico, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
d Servicio Anatomía Patológica, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Servicio Oncología Médica, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
f Servicio de Oncología Radioterápica, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
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Abstract
Introduction

Surgery is the accepted treatment in adenocarcinoma of the head of the pancreas (ADHP); however, the long-term survival continues to be low. The aim of this study is to define prognostic factors of long-term survival after cephalic duodenopancreatectomy (CDP) due to pancreatic adenocarcinoma.

Material and methods

We have collected data on the treatment of adenocarcinoma of the head of the pancreas by means of a cephalic duodenopancreatectomy performed at the Hospital Universitari de Bellvitge (Barcelona) from 1991 to 2007.

Results

A total of 204 CDP due to ADHP were performed. The histology showed that the resected tumour was larger than 3cm in 70 cases, with lymphatic infiltration in 73%, perineural invasion in 89%, and lymphatic involvement in 89%. More than 15 lymph nodes were resected in 120 patients. A total of 113 (60%) patients received adjuvant treatment after surgery. There were 148 (73%) deaths, of which 55 (27%) were alive at closure. The actual mean survival was 2.54 years (95% CI; 2.02–3.07) and an actuarial survival at 5 years of 13.55% (95% CI; 7.69–19.41).

The study of mortality risk factors showed that, female gender, absence of peri-operative transfusion (P=.003), the resection of more than 15 lymph nodes during the operation (P=.004), and the administration of adjuvant treatment (P=.004) had a better long-term prognosis. The multivariate analysis showed that transfusion and gender were the most significant variables.

Conclusions

Surgery of head of the pancreas adenocarcinoma must include an adequate lymphadenectomy, and must be performed with a low morbidity and without the need of a peri-operative transfusion.

Keywords:
Pancreatic cancer
Pancreatic adenocarcinoma
Cephalic duodenopancreatectomy
Pancreas cancer surgery
Long-term survival
Resumen
Objetivo

Definir factores pronóstico de supervivencia a largo plazo tras la duodenopancreatectomía cefálica por adenocarcinoma pancreático.

Introducción

La cirugía es el tratamiento aceptado en el adenocarcinoma de páncreas cefálico, sin embargo la supervivencia a largo plazo sigue siendo baja.

Material y métodos

Hemos recogido la experiencia en el tratamiento del adenocarcinoma de cabeza de páncreas (ADCP) en el Hospital Universitari de Bellvitge mediante duodenopancreatectomía cefálica (DPC) desde 1991 hasta 2007.

Resultados

Se realizaron 204 DPC por ADCP. El estudio histológico evidenció que el tumor resecado tenía un tamaño superior a 3 cm en 70, con permeación linfática en un 73%, invasión perineural en 89% y afectación linfática en 71%. En 120 pacientes se resecaron más de 15 adenopatías. Tras la cirugía, se administró tratamiento adyuvante a 113 pacientes (60%). Se contabilizaron 148 fallecimientos (73%), estando vivos al cierre del mismo 55 (27%). La supervivencia actual media fue de 2,54 años (IC 95% 2,02–3,07) y la supervivencia actuarial a 5 años de 13,55% (IC 95% 7,69–19,41).

El estudio de factores de riesgo de mortalidad reveló que el sexo femenino (p=0,005), la ausencia de transfusión perioperatoria (p=0,003), la resección de más de 15 adenopatías en la intervención (p=0,004) y la administración de tratamiento adyuvante (p=0,004) comportaron mejor pronóstico a largo plazo. El estudio multivariante demostró que transfusión y sexo fueron las variables de interés.

Conclusiones

La cirugía del adenocarcinoma de cabeza de páncreas debe incluir una linfadenectomía suficiente y debe realizarse con baja morbilidad y sin necesidad de transfusión perioperatoria.

Palabras clave:
Cáncer de páncreas
Adenocarcinoma pancreático
Duodenopancreatectomía cefálica
Cirugía oncológica del páncreas
Supervivencia a largo plazo
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