| Objective: The anatomical structure of ampullary cancer,distal bile duct cancer,duodenal papillary cancer and pancreatic head cancer is all located in biliary-pancreatic junction region.They have a same origin of tissue which occurs in the embryonic intestine,that have become different organizational structures with differentiation of cell.Therefore,we study comparatively the clinical difference and explore the prognositic factors of four types of tumors performed pancreaticoduodenectomy.Methods: We analyzed retrospectively the clinicopathologic feature of159 patients with ampullary cancer,distal bile duct cancer,duodenal papillary cancer and pancreatic head cancer which performed pancreaticoduodenectomy at Hepatobiliary Surgery,4th Hospital of Hebei Medical University from January 2014 to July 2017.Multivariate analysis of COX model was used to investigate the independent determinants of the prognosis for the four tumors after pancreaticoduodenectomy.Results: There was no statistical difference in age composition among ampullary cancer,distal bile duct cancer,duodenal papillary cancer and pancreatic head cancer(P>0.05).For gender,the proportion of male and female in distal bile duct cancer group was higher significantly than the other three groups(P <0.05),and the ratio of men and women was 4.14:1.Preoperative conditions: For tumor diameter,the pancreatic head cancer group was significantly larger than the ampullary cancer group,the distal bile duct cancer group and the duodenal papillary cancer group(P<0.05).There was no statistical difference among the four groups in lymph node metastasis(P>0.05).ALT in the duodenal papillary cancer group was significantly lowerthan that in the ampullary cancer group,the distal bile duct cancer group and the pancreatic head cancer group(P<0.05).AST in the duodenal papillary cancer group was significantly lower than that in the ampullary cancer group and the distal bile duct cancer group(P<0.05).TBIL in the distal bile duct cancer group was significantly higher than that in the pancreatic head cancer group and the duodenal papillary cancer group,and TBIL in the ampullary cancer group was significantly higher than that in the duodenal papillary carcinoma group(P<0.05).There was no significant difference in Hb,TP,ALB and CA19-9 among the four groups on admission(P>0.05).Intraoperative conditions:There was no statistical difference in intraoperative blood loss and operation time among the ampullary cancer group,the distal bile duct cancer group,the duodenal papillary cancer group and the pancreatic head cancer group(P>0.05).Postoperative conditions: There were 32 postoperative complications in159 patients in all groups,thirteen in the ampullary cancer group,six in the distal bile duct cancer group,four in the duodenal papillary cancer group,nine in the pancreatic head cancer group,and there was no significant difference among the four groups(P>0.05),and there was no significant difference in postoperative hospitalization among the four groups too(P>0.05).Univariate survival analysis showed that the survival rates of 1,2,and 3 years in patients with ampullary cancer were 88.2%,69% and 46.1%,and the average survival time was 31.17±1.99 months.The survival rates of 1,2 and3 years in patients with distal bile duct cancer were 88.6%,59.4% and 38.5%,and the average survival time was 28.29±2.92 months.The survival rates of1,2 and 3 years in patients with duodenal papillary cancer were 90.2%,79.3%,and 52.8%,and the average survival time was 32.75±1.37 months.The survival rates of 1,2 and 3 years in patients with pancreatic head cancer were 69.8%,30.8%,and 20.5%,and the average survival time was 19.21±2.40 months.The survival rate of pancreatic head cancer group was significantly lower than that of ampullary cancer group,distal bile duct cancer group and duodenal papillary cancer group(P<0.05).Multivariate analysis of the COX proportional hazards model showed that tumor diameter >2cm,lymphatic metastasis,TP ? 65 g/L,ALB?40 g/L and pancreatic head cancer were the independent determinants of prognosis for the four tumor patients after pancreaticoduodenectomy.Conclusions:1.The tumor size of pancreatic head cancer on admission was significantly greater than that of ampullary cancer,distal bile duct cancer and duodenal papillary cancer.2.The liver function of the duodenal papillary cancer on admission was better than that of pancreatic head cancer,ampullary cancer and distal bile duct cancer.3.The prognosis of pancreatic head cancer was worse than that of ampullary cancer,distal bile duct cancer and duodenal papillary cancer.4.Tumor diameter >2cm,lymphatic metastasis,TP ? 65 g/L,ALB?40g/L and pancreatic head cancer were the independent determinants of prognosis for four tumor patients after pancreaticoduodenectomy. |
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