https://scholars.lib.ntu.edu.tw/handle/123456789/461878
標題: | Is blind pancreaticoduodenectomy justified for patients with ampullary neoplasms? | 作者: | YU-WEN TIEN CHI-CHUAN YEH Wang S.-P. REY-HENG HU PO-HUANG LEE |
公開日期: | 2009 | 卷: | 13 | 期: | 9 | 起(迄)頁: | 1666-1673 | 來源出版物: | Journal of Gastrointestinal Surgery | 摘要: | Background - Many specialists justify pancreaticoduodenectomy (PD) for pancreatic head neoplasms with suspected but unproven malignance (blind-PD). Our aim in this study was to determine whether blind-PD is also justified for ampullary neoplasms. Methods - We retrospectively reviewed the records of all patients with presumed resectable ampullary neoplasms treated at the National Taiwan University Hospital from 1998 to 2008. Results - Of the 84 patients without a preoperative tissue diagnosis of malignance, 64 had blind-PD and 20 had ampullectomy (AMP) with intraoperative frozen section. Patients with jaundice, gastrointestinal bleeding, imaging findings showing tumor invasion, and larger tumor size were significantly more frequently treated by blind-PD. Final pathological diagnosis was benign in ten of 64 blind-PD-treated patients. Conclusions - Our data support a selective use of blind-PD because (1) a significant portion (65%) of benign ampullary neoplasms can be safely and effectively treated by AMP, (2) blind-PD does not treat ampullary cancer at earlier stage, and (3) blind-PD is associated with significantly more complications and significantly longer hospital stay than AMP. However, blind-PD is strongly recommended for patients with large ampullary neoplasms (>3 cm in diameter), with jaundice, or with malignant endoscopic appearance. ? 2009 The Society for Surgery of the Alimentary Tract. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-70349427040&doi=10.1007%2fs11605-009-0943-2&partnerID=40&md5=2657e2b2edb7c5514ba40f1c693fb744 https://scholars.lib.ntu.edu.tw/handle/123456789/461878 |
ISSN: | 1091-255X | DOI: | 10.1007/s11605-009-0943-2 | SDG/關鍵字: | aged; article; cancer invasion; cancer staging; cohort analysis; comparative study; disease free survival; endoscopic retrograde cholangiopancreatography; endoscopic sphincterotomy; female; follow up; human; immunohistochemistry; male; methodology; middle aged; mortality; needle biopsy; nonparametric test; pancreas tumor; pancreaticoduodenectomy; pathology; postoperative complication; preoperative care; probability; register; retrospective study; risk assessment; survival rate; Vater papilla; Aged; Ampulla of Vater; Biopsy, Needle; Cholangiopancreatography, Endoscopic Retrograde; Cohort Studies; Disease-Free Survival; Female; Follow-Up Studies; Hospital Mortality; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Preoperative Care; Probability; Registries; Retrospective Studies; Risk Assessment; Sphincterotomy, Endoscopic; Statistics, Nonparametric; Survival Rate |
顯示於: | 醫學系 |
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