Prognostic Analysis Of Pancreaticoduodenectomy After Tumors In Different Parts Of Pancreatic Head Area

Objective: To investigate the location,clinical factors and the relationship between recurrence rate and survival rate of five groups of malignant tumors,including ampullary cancer,distal cholangio carcinoma,pancreatic head cancer,uncinate process cancer and pancreatic neck cancer.Methods: the clinical data and follow-up data of 92 patients with pancreatoduodenectomy in the First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively,The 3-year survival rate and median survival time were compared by Kaplan Meier method.The survival status and single factor survival analysis were compared among the follow-up tumor patients.The Cox proportional risk model was used to analyze the multi factor survival of five groups of tumors.Results: 1.Skin sclera yellow staining was the most common in ampullary cancer and lower bile duct cancer(75.0%,88.9%),abdominal pain(75%,85.7%)and weight loss(70%,71.4%)were more common in uncinate process and pancreatic neck.2.There were 49 males(53.3%)and 43 females(46.7%)with an average age of 65.00(53.25,72.00).Univariate analysis showed that there was no significant difference in gender,age and prognosis(P =0.536,P = 0.061).3.The 12-month recurrence rate of tumors in the five groups was12.5% for ampullary cancer,22.2% for lower bile duct cancer,45.8% for pancreatic head cancer,60% for uncinate process cancer and 71.4% for pancreatic neck cancer.There was statistical difference(P ? 0.05).4.The recurrence rate and survival rate of the five groups were statistically significant(P ? 0.05);the three survival rates of the five groups were 56.3%(36.0),44.4%(25.0),20.5%(20.0),15.0%(17.0)and 14.3%(14.0),respectively.5.Cox regression analysis after adjustment of various confounding factors showed that lymph invasion,vascular invasion,R0 resection rate,tumor diameter,AJCC stage ? and tumor growth site(uncinate process,pancreatic neck)were all related risk factors for postoperative recurrence and long-term survival(P < 0.05).Conclusion:Compared with pancreatic head cancer,uncinate process cancer and pancreatic neck cancer,ampullary cancer and lower cholangiocarcinoma are more common with jaundice,and total bilirubin is significantly higher than uncinate process cancer and pancreatic neck cancer.2.2.The age and sex of patients had no significant effect on the long-term survival of ampullary carcinoma,lower segment of bile duct,head of pancreas,uncinate process and neck of pancreas.3.The patients with uncinate process cancer and pancreatic neck cancer have high rate of vascular invasion,lymph node metastasis,late stage of tumor,high recurrence rate one year after operation and poor prognosis.4.Vascular invasion,lymphoid invasion,R0 resection rate,tumor diameter,tumor stage ?,tumor site(uncinate process,pancreatic neck)were all independent risk factors for postoperative recurrence and long-term survival.