췌두부선암 절제 후 장기 생존자의 분석
Analysis of Long-term Survivors after Pancreatoduodenectomy in the Patients with Pancreatic Cancer
장진영, 이건욱, 박용현, 김우호, 김선회, 이혜승, 박상재, 박윤찬,
소속 상세정보
장진영 ( Jang Jin-Young )
서울대학교 의과대학 외과학교실
이건욱 ( Lee Kuhn-Uk )
서울대학교 의과대학 외과학교실
박용현 ( Park Yong-Hyun )
서울대학교 의과대학 외과학교실
김우호 ( Kim Woo-Ho )
서울대학교 의과대학 병리학교실
김선회 ( Kim Sun-Whe )
서울대학교 의과대학 외과학교실
이혜승 ( Lee Hye-Seung )
서울대학교 의과대학 병리학교실
박상재 ( Park Sang-Jae )
서울대학교 의과대학 외과학교실
박윤찬 ( Park Yun-Chan )
서울대학교 의과대학 외과학교실
KMID : 0371320010600010089
Abstract
Purpose: Pancreatic ductal adenocarcinoma is known to be very dismal. Although some publications reported marked improved survival data after surgical resection recently, many clinicians have pessimistic views on the treatment of pancreatic cancer. So we set the objectives of this study to evaluate the clinical results of pancreatoduodenectomy in pancreatic cancer and investigate what constitutes long term survival after pancreatoduodenectomy for pancreatic cancer.
Methods: We analyzed 286 patients with pancreatic head ductal adenocarcinoma hospitalized in Seoul National University Hospital between 1985 and 1995, retrospectively. We excluded the patients with cystic pancreatic tumor and solid pseudo-papillary tumor in this study. Of them, 67 patients received pancreatoduodenectomy. We re-reviewed the histologic specimens of resected cases and tried to find clinico- pathological features in long-term survivors after pancreatoduodenectomy.
Results: Median survival of total patients with pancreatic head cancer was 8 months. Significant survival difference could be found between resected cases (15 months) and non-resected cases (6 months)
(p＜0.001). Of the patients who underwent pancreatoduodenectomy, there were nine patients who survived more than three years. In the patients who underwent pancreatoduodenectomy, depth of invasion, lymph node metastasis, UICC stage, CEA level, adjuvant chemotherapy were the prognostic factors. After histologic re-review in the long-term survivors, there were only 4 typical ductal adenocarcinoma, and 2 cases of variant ductal adeno-carcinoma (mucinous noncystic adenocarcinoma, undifferentiated adenocarcinoma), the others were re-diagnosed with bile duct cancer, papillary mucinous carcinoma, and pancreatoblastoma. When we excluded the patients with non ductal adenocarcinoma according to the pathologic review, the median survival of the patients with pancreatoduodenectomy (n=64) decreased (14 months).
Conclusion: Only the 2% of all the pancreatic cancer and 11% of the resected cases could be considered as ’cure’. In the long-term survivors, there were various types of pathology associated with good prognosis, so typical ductal adenocarcinoma of pancreas would have poorer prognosis than expected. Careful pathologic review must be preceded in the analyzing the survival data.
키워드
췌장암;췌십이지장 절제술;장기생존자
Pancreatic cancer;Pancreatoduodenectomy;Long-term survivor
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