Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (group A), 19 patients under 65 years of age were treated by surgical biliary bypass (group B) and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage (group C). Then the therapeutic results were compared.Results With respect to the postoperative level of serum bilirubin, the incidence of early complications, postoperative hospitalization and mean survival time, no statistically significant difference was found between group A and B (Pgt;0.05). There was one case of recurrent jaundice and one case of gastric output obstruction in group B, while no one suffered postoperative complication in group A, and the difference was statistically significant (Plt;0.01). Compared with group A, the postoperative level of serum bilirubin, the number of patient readmitted, the rate of recurrent jaundice and gastric output obstruction were higher in group C (Plt;0.05 or Plt;0.01). The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A (Plt;0.05 or Plt;0.01, respectively). Conclusion Surgical palliation does not increase the morbidity rate, but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.
ObjectiveTo investigate the correlation with clinicopathologic factors and prognosis in pancreatic head cancer following radical resection. MethodsThirteen-eight patients with primary pancreatic head cancer admitted into Urumuqi General Hospital of Lanzhou Military Region from January 2000 to December 2007 were treated by radical resection, the clinicopathologic factors were retrospectively analyzed, the SPSS 17.0 analysis software was used to analyze the relation between clinicopathologic factors and prognosis. Results①The follow-up rate was 81.6%(31/38), the 1-and 2-year overall survival was 38.7% and 12.9%, respectively.②Spearman analysis showed that the distant metastasis was significantly correlated with the tumor size(rs=0.421, P=0.008)and TNM stage(rs=0.746, P=0.000); the lymph node metastasis was significantly correlated with TNM stage(rs=0.543, P=0.001)and was not correlated with tumor differentiation degree(rs=0.074, P=0.695), the tumor size was also significantly correlated with TNM stage (rs=0.475, P=0.003).③Univariate Chi-Square test revealed that the gender(P=0.045), tumor size(P=0.004), tumor differentiation degree(P=0.003), TNM stage(P=0.000), distant metastasis(P=0.002), and lymph node metastasis(P=0.001)were correlated with the prognosis of pancreatic head cancer. However, when the interactive effects of those factors were taken into account, TNM stage(P=0.001), differentiation degree(P=0.003), and lymph node metastasis(P=0.007)were selected as the most significant prognostic factors in a multivariate analysis by using the Cox proportional hazard regression model.④The survival rate of patients with low differentiation degree was significantly shorter than that of moderate/high differentiation degree(P=0.003), of patients withⅠ+Ⅱstages was significantly longer than that ofⅢ+Ⅳstages(P=0.000), of patients with distant metastasis or lymph node metastasis was significantly lower than those patients without distant metastasis or lymph node metastasis(P=0.002, P=0.001). ConclusionsThe lymph node metastasis is significantly associated with TNM stage, and is not associated with differentiation degree. The lymph node metastasis, differentiation degree, and TNM stage are related with survival, and they are also independent prognostic factors of pancreatic head cancer.