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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Pancreas-sparing duodenectomy with regional lymph node dissection for early-stage ampullary carcinoma: A case control study using propensity scoring methods
Bin Liu, Jing Li, Yong-Jiu Zhang, Lu-Nan Yan, Sheng-Yi You, Wan-Yee Lau, Hao-Ran Sun, Shi-Yan Yan, Zhi-Qiang Wang
Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China
Jing Li, Department of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin 300052, China
Yong-Jiu Zhang, Department of General Surgery, Urumqi General Hospital of Lanzhou Military Region, PLA, Urumqi 830000, Xinjiang Autonomous Region, China
Lu-Nan Yan, Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Sheng-Yi You, Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300052, China
Wan-Yee Lau, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
Hao-Ran Sun, Department of Radiology, General Hospital of Tianjin Medical University, Tianjin 300052, China
Shi-Yan Yan, Institute of Clinical Basic Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
Author contributions: Liu B and Li J are co-first authors, and they contributed equally to the work; Liu B, Li J and Wang ZQ designed the research; Zhang YJ, Yan LN, You SY, Sun HR treated the patients and collected material and clinical data from the patients; Liu B, Li J, and Yan SY performed the assays; Liu B, Li J, Yan SY and Wang ZQ analysed the data; Liu B, Li J and Lau WY wrote the paper.
Supported by National Natural Science Foundation of China, No. 81170453 and No. 81301025; Tianjin City High School Science and Technology Fund Planning Project, No. 20120118.
Ethics approval: This study was approved by the Ethics Board at the General Hospital of Tianjin Medical University.
Informed consent: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors state that there is no conflict of interests related to this paper.
Data sharing: Dataset available from the corresponding author at (surgeryliubin@163.com). Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China. surgeryliubin@163.com
Telephone: +86-22-60362636
Received: September 16, 2014
Peer-review started: September 18, 2014
First decision: October 29, 2014
Revised: November 16, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: May 14, 2015
AIM: To investigate the outcomes of pancreas-sparing duodenectomy (PSD) with regional lymph node dissection vs pancreaticoduodenectomy (PD).
METHODS: Between August 2001 and June 2014, 228 patients with early-stage ampullary carcinoma (Amp Ca) underwent surgical treatment (PD, n = 159; PSD with regional lymph node dissection, n = 69). The patients were divided into two groups: the PD group and the PSD group. Propensity scoring methods were used to select patients with similar disease statuses. A total of 138 matched cases, with 69 patients in each group, were included in the final analysis.
RESULTS: The median operative time was shorter among the patients in the PSD group (435 min) compared with those in the PD group (481 min, P = 0.048). The median blood loss in the PSD group was significantly less than that in the PD group. The median length of hospital stay was shorter for patients in the PSD group vs the PD group. The incidence of pancreatic fistula was higher among patients in the PD group vs the PSD group. The 1-, 3-, and 5-year overall survival and disease-free survival rates for patients in the PSD group were 83%, 70%, 44% and 73%, 61%, 39%, respectively, and these values were not different than compared with those in the PD group (P = 0.625).
CONCLUSION: PSD with regional lymph node dissection presents an acceptable morbidity in addition to its advantages over PD. PSD may be a safe and feasible alternative to PD in the treatment of early-stage Amp Ca.
Core tip: The median operative time and hospital stay were shorter among the patients in the pancreas-sparing duodenectomy (PSD) group compared with those in the pancreaticoduodenectomy (PD) group. The median blood loss in the PSD group was significantly less than that in the PD group. The incidence of pancreatic fistula was higher among patients in the PD group vs the PSD group. The 1-, 3-, and 5-year overall survival and disease-free survival rates for patients in the PSD group were not different compared with those in the PD group. These data suggest that PSD with regional lymph node dissection may be a safe and feasible alternative to PD in the treatment of early-stage ampullary carcinoma.
