A Real-world Study On The Characteristics Of Surgical Treatment And Prognostic Analysis Of Pancreatic Head Cancer

Objective:Through the hospital information platform system,the EXCEL database of pancreatic cancer patients in Dalian Central Hospital affiliated to Dalian Medical University is established,the real world data of pancreatic cancer are analyzed,and the real world data of pancreatic head cancer patients undergoing radical surgery and palliative jaundice reduction are selected.To compare the real world data of laparoscopically assisted pancreaticoduodenectomy,open pancreaticoduodenectomy,palliative choledochojejunostomy and percutaneous transhepatic biliary drainage（percutancoustranshepaticcholangialdrainage,PTCD）,to evaluate the clinical characteristics,advantages and disadvantages of different surgical treatments for pancreatic head cancer in the real world,and to supplement the real world data for the clinical treatment of pancreatic head cancer.Try to obtain real-world evidence about surgical treatment of pancreatic head cancer by means of real-world research,so as to provide effective guidance for clinicians.Methods:Based on the hospital information platform system,the clinical data of 344 patients diagnosed with pancreatic cancer from January 1,2017to December 31,2021 were collected,and all the data were recorded into Excel database.According to the purpose of the study,the patients were divided into radical treatment group（82 cases）and palliative jaundice reducing group（77 cases）.The radical treatment group was further divided into open pancreaticoduodenectomy group（39 cases）and laparoscopic assisted pancreaticoduodenectomy group（43 cases）.Palliative jaundice reduction group was divided into palliative choledochojejunostomy group（42cases）and PTCD group（35 cases）.And make a systematic analysis and multi-dimensional interpretation of these data.After finishing the data,the SPSS25.0 version was used for statistical analysis:1.The measurement data describing normal distribution are expressed as mean±standard deviation（mean±standard deviation）,and independent sample t-test is used for inter-group comparative analysis.2.The statistical analysis of the measurement data of non-normal distribution is expressed by M(P₂₅,P₇₅),and the relationship between the two groups is compared by Mann-Whitney U test（rank sum test）.3.χ²test is used to analyze and compare the counting data,which is expressed by the number of examples.4.Using Log-rank test to evaluate the difference of univariate prognosis.5.Independent risk factors affecting prognosis were determined by Cox multivariate regression model analysis.6.Using Kaplan-Meier method to draw the survival curve of each independent risk factor.7.P<0.05 was regarded as the difference was statistically significant.Results:1.The EXCEL database of 344 patients with pancreatic cancer was established,including a series of continuous data,such as basic conditions,examination results,treatment methods,postoperative pathological manifestations,postoperative complications and follow-up.The main treatment methods of patients with pancreatic head cancer were identified,159 patients with pancreatic head cancer were selected,and the basic situation of surgical treatment was mastered.2.Among the 82 patients with pancreatic head cancer in the radical treatment group,the actual hospital stay in the open pancreaticoduodenectomy group was significantly higher than that in the laparoscopic-assisted pancreaticoduodenectomy group.Univariate analysis in radical treatment group showed that the prognosis of patients with pancreatic head cancer was related to postoperative 3-day albumin level,T stage,N stage,postoperative pancreatic fistula,postoperative hemorrhage and postoperative adjuvant chemotherapy（P<0.05）.Multivariate analysis showed that postoperative 3-day albumin,T stage,postoperative pancreatic fistula,postoperative hemorrhage and postoperative adjuvant chemotherapy were independent risk factors affecting the prognosis of patients with pancreatic head cancer（P<0.05）.3.In 77 cases of palliative jaundice reduction group,ALT,AST and TBIL in palliative choledochojejunostomy group were significantly lower than those in PTCD group 3 days after operation,while the actual hospital stay and survival time were significantly higher than those in PTCD group.Univariate analysis in palliative surgery group showed that the prognosis of patients with pancreatic head cancer was correlated with first admission albumin level,T stage and M stage（P<0.05）.The results of multivariate analysis showed that T stage and M stage were independent risk factors affecting the prognosis of patients with pancreatic head cancer（P<0.05）.Conclusion:1.Laparoscopically assisted pancreaticoduodenectomy can shorten the actual hospital stay of patients with pancreatic head cancer,and there is no significant difference between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in postoperative complications and survival time.Clinical practice is recommended,but the safety and benefits need to be further studied.2.TNM stage,albumin level 3 days after operation,postoperative pancreatic fistula,postoperative bleeding and postoperative adjuvant chemotherapy are independent risk factors affecting the prognosis of pancreatic head cancer patients undergoing pancreaticoduodenectomy.Patients with pancreatic head cancer are recommended to receive individualized postoperative adjuvant chemotherapyafterradicaloperation.3.Bothpalliative choledochojejunostomy and PTCD can achieve the purpose of reducing jaundice in patients with pancreatic head cancer with obstructive jaundice.Although palliative choledochojejunostomy may prolong the actual hospital stay of patients with pancreatic head cancer,the recovery of liver function and survival time after operation are better than those in PTCD group.Palliative jaundice reduction should be given priority in patients with pancreatic head cancer with biliary obstruction.