Pancreas-sparing duodenectomy with regional lymph node dissection for early-stage ampullary carcinoma: A case control study using propensity scoring methods.
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.
['Liu|Bin|B|', 'Li|Jing|J|', 'Zhang|Yong-Jiu|YJ|', 'Yan|Lu-Nan|LN|', 'You|Sheng-Yi|SY|', 'Lau|Wan-Yee|WY|', 'Sun|Hao-Ran|HR|', 'Yan|Shi-Yan|SY|', 'Wang|Zhi-Qiang|ZQ|']
D000328:Adult D000368:Aged D014670:Ampulla of Vater D001706:Biopsy D002277:Carcinoma D003138:Common Bile Duct Neoplasms D013505:Digestive System Surgical Procedures D018572:Disease-Free Survival D004384:Duodenoscopy D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D007902:Length of Stay D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008297:Male D008875:Middle Aged D009367:Neoplasm Staging D059351:Organ Sparing Treatments D010185:Pancreatic Fistula D016577:Pancreaticoduodenectomy D057216:Propensity Score D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
Ampullary carcinoma Propensity scoring methods Surgical treatments Early stage Prognosis