Pancreaticoduodenectomy for XXXX of the head of the pancreas: long-term survival analysis.

@entity1 @entity14380 @entity4294 @entity5 @entity9608 @entity26290 @entity7581
Pancreaticoduodenectomy (PD) has been performed infrequently for @entity4294 of the pancreas because of the perceived perioperative morbidity and the relatively protracted natural history of those @entity5 . To determine whether the improved safety of PD affects long-term outcome of @entity1 with @entity4294 , we reviewed our experience. All consecutive @entity1 who underwent PD or total pancreatectomy for @entity4294 between 1980 and 1995 were analyzed. Diagnoses were based on histologic findings and endocrine (biochemical) manifestations of the @entity5 . @entity1 were followed by outpatient clinic visits and mail correspondence. Clinical and pathologic factors were analyzed for prognostic risk. Survival and recurrence curves were generated using the Kaplan-Meier method, and the log-rank test was used for comparison (p <0.05 was significant). We identified 29 @entity1 who fulfilled the inclusion criteria with an even distribution by gender (14M:15F). Mean age of @entity1 was 56 years (SD +/- 14 years); mean @entity5 size was 4.4 cm (SD +/- 2.6 cm). Most @entity5 were nonfunctioning (n = 20); there were 4 @entity26290 , @entity9608 , and 2 @entity7581 . Operating time was 316 minutes (SD +/- 75 minutes), median transfusion requirement was 0 units (mean 1.5 units). Standard Whipple resection was performed in 20 @entity1 ; the pylorus-preserving Whipple procedure, in 7; and total pancreatectomy, in 2. Regional lymph nodes were involved by @entity5 in 16 @entity1 . The complication rate was 31%, and operative mortality was 10% (n = 3). Length of hospital stay was 17 days (SD +/- 8.8 days). Overall survival was 81% and 70% at 5 and 10 years. Recurrence-free survival was 76% at 5 and 10 years. There was a trend toward greater recurrence-free survival for node-negative @entity1 (88% vs 65% at 5 years, p = 0.13), and overall survival was greater for node-negative @entity1 (100% vs 67% at 5 years, p = 0.04). Mean follow-up was 8.8 years. PD is an appropriate strategy for selected @entity14380 , which offers extended survival with a low recurrence rate and control of endocrine symptoms.
