[Comparative clinical efficacy analysis of pancreatoduodenectomy for distal bile duct and pancreatic head cancer: a report of 1 005 cases].

Objective: To compare and analyze the clinical efficacy of pancreaticoduodenectomy for distal bile duct cancer and pancreatic head cancer. Methods: Clinical data of 1 005 patients who underwent pancreaticoduodenectomy and postoperative pathological examination confirmed the diagnosis of distal bile duct cancer and pancreatic head cancer at the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were analyzed retrospectively. There were 112 cases in the distal bile duct cancer group, 71 males and 41 females,with age (M(IQR)) of 65(15) years(range: 40 to 87 years); 893 cases in the pancreatic head cancer group, 534 males and 359 females,with age of 64(13)years(range: 16 to 91 years). The differences between clinicopathological characteristics and postoperative overall survival of the two groups were analyzed by χ2 test, Fisher's exact probability method, rank sum test or log-rank test, respectively. The difference in postoperative overall survival between the two groups was compared using Kaplan-Meier method after propensity score matching (1∶1). Results: Compared with the pancreatic head cancer group,the distal bile duct cancer group had shorter operative time (240.0(134.0) minutes vs. 261.0(97.0) minutes, Z=2.712, P=0.007),less proportion of combined venous resection (4.5% (5/112) vs. 19.4% (173/893), χ²=15.177,P<0.01),smaller tumor diameter (2.0(1.0) cm vs. 3.0(1.5) cm,Z=10.567,P<0.01),higher well/moderate differentiation ratio (51.4% (56/112) vs. 38.0% (337/893), χ²=7.328, P=0.007),fewer positive lymph nodes (0(1) vs. 1(3), Z=5.824, P<0.01),and higher R0 resection rate (77.7% (87/112) vs. 38.3%(342/893), χ²=64.399, P<0.01),but with a higher incidence of overall postoperative complications (50.0% (56/112) vs. 36.3% (324/892), χ²=7.913,P=0.005),postoperative pancreatic fistula (28.6% (32/112) vs. 13.9% (124/893), χ²=16.318,P<0.01),and postoperative abdominal infection (21.4% (24/112) vs. 8.6% (77/892), χ²=18.001,P<0.01). After propensity score matching, there was no statistical difference in postoperative overall survival time between patients in the distal bile duct cancer group and the pancreatic head cancer group (50.6 months vs. 35.1 months,Z=1.640,P=0.201),and multifactorial analysis showed that tumor site was not an independent risk factor affecting the prognosis of patients in both groups after matching (HR=0.73,95%CI:0.43 to 1.23,P=0.238). Conclusions: Patients with distal bile duct cancer are more likely to benefit from early diagnosis and surgical treatment than patients with pancreatic head cancer,but with a relative higher postoperative complication rates. The different tumor origin site is not an independent risk factor for prognosis of patients with distal bile duct cancer and pancreatic head cancer after propensity score matching.目的： 比较胰十二指肠切除术治疗远端胆管癌和胰头癌的临床效果。 方法： 回顾性分析2016年1月至2020年12月于南京医科大学第一附属医院胰腺中心行胰十二指肠切除术且术后病理学检查结果为远端胆管癌或胰头癌的1 005例患者的临床和病理学资料。其中远端胆管癌组112例，男性71例，女性 41例，年龄为［M（IQR）］65（15）岁（范围：40~87岁）；胰头癌组893例，男性534例，女性359例，年龄为64（13）岁（范围：16~91岁）。通过χ²检验、Fisher确切概率法、秩和检验或Log-rank检验分析两组患者临床病理学特征和术后生存时间之间的差异。采用倾向性评分匹配的方法，按1∶1匹配后，通过Kaplan-Meier法比较两组患者术后总体生存时间的差异。 结果： 与胰头癌组相比，远端胆管癌组手术时间短［240.0（134.0）min比261.0（97.0）min；Z=2.712，P=0.007］，联合静脉切除比例低［4.5%（5/112）比19.4%（173/893）；χ²=15.177，P<0.01］，肿瘤最大径小［2.0（1.0）cm比3.0（1.5）cm；Z=10.567，P<0.01］，肿瘤高中分化比例高［51.4%（56/112）比38.0%（337/893）；χ²=7.328，P=0.007］，阳性淋巴结数目少［0（1）枚比1（3）枚；Z=5.824，P<0.01］，R0切除率高［77.7%（87/112）比38.3%（342/893）；χ²=64.399，P<0.01］，但术后总体并发症［50.0%（56/112）比36.3%（324/892）；χ²=7.913，P=0.005］、术后胰瘘［28.6%（32/112）比13.9%（124/893）；χ²=16.318，P<0.01］、术后腹腔感染［21.4%（24/112）比8.6%（77/892）；χ²=18.001，P<0.01］的发生率更高。倾向性评分匹配后，远端胆管癌组与胰头癌组患者术后生存时间的差异无统计学意义（50.6个月比35.1个月；Z=1.640，P=0.201）；多因素分析结果显示，肿瘤部位并不是患者预后的独立影响因素（HR=0.73，95%CI：0.43~1.23，P=0.238）。 结论： 与胰头癌患者相比，远端胆管癌患者更能从早期诊断和手术治疗中获得生存获益，但其术后并发症发生率高于胰头癌患者。肿瘤的发生部位不是影响远端胆管癌和胰头癌患者预后的独立影响因素。.