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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 methodsWe 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.
ResultsA 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.
ConclusionsSurgery 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.
IntroducciónLa cirugía es el tratamiento aceptado en el adenocarcinoma de páncreas cefálico, sin embargo la supervivencia a largo plazo sigue siendo baja.
Material y métodosHemos 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.
ResultadosSe 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.
ConclusionesLa 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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