Chirurgische Therapie und prognostische Faktoren des Papillenkarzinoms

Zusammenfassung

Hintergrund: Das Papillenkarzinom ist ein seltener Tumor des Gastrointestinaltrakts und unterscheidet sich bezüglich der Prognose von anderen periampullären Tumoren. Die Analyse des Überlebens sowie möglicher Prognosefaktoren ist aufgrund der geringen Inzidenz des Karzinoms schwierig. Ziel dieser Studie war die Analyse des Kurz- und Langzeitüberlebens sowie die Identifikation prognostischer Faktoren bei Patienten mit Papillenkarzinom und Duodenopankreatektomie und Rekonstruktion mittels Pankreatogastrostomie. Patienten und Methoden: Zwischen 1989 und 2008 wurden 76 Patienten mit einem Papillenkarzinom duodenopankreatektomiert, die Rekonstruktion erfolgte mittels Pankreatogastrostomie. Im Rahmen einer retrospektiven Analyse wurden verschiedene Faktoren (Demografie, perioperative Faktoren, Histopathologie) und ihr Einfluss auf das Kurz- und Langzeitüberleben untersucht. Die statistische Analyse erfolgte mittels Kaplan-Meier-Kurven, mögliche prognostische Parameter wurden einer uni- und multivariaten Analyse mit Cox-Regression unterzogen. Ergebnisse: Die 5-Jahres-Überlebensrate (JÜR) betrug 46 %, die 10-JÜR 26 %. In der univariaten Analyse war der einzig relevante Parameter bezüglich des Überlebens der Lymphknotenstatus (LK-Status). In der multivariaten Analyse konnten Geschlecht, Alter, Grading sowie insbesondere der N-Status als signifikante Parameter identifiziert werden. Schlussfolgerung: In dem aktuell untersuchten Patientenkollektiv hat der Lymphknotenstatus die höchste prognostische Vorhersagekraft bezüglich des Langzeitüberlebens bei Patienten mit Papillenkarzinomen.

Abstract

Background: Carcinoma of ampulla of Vater are rare tumours of the GI-tract with an improved prognosis compared to other periampullary tumours. Analysis of survival and prognostic factors are limited due to the low incidence of the carcinoma. The intention of this study in patients with papillary carcinoma was to evaluate short- and long-term survival and to identify prognostic factors for pancreatectomy and reconstruction using pancreatogastrostomy as treatment of carcinoma of Vaterʼs ampulla. Patients and Methods: Between 1989 and 2008 76 patients with a carcinoma of the ampulla of Vater were treated by oncological resection followed by pancreatogastrostomy. Various factors such as demographics, perioperative factors, histopathological findings as well as short- and long-term survival were evaluated retrospectively. Data were analysed statistically using Kaplan-Meier estimates of survival with log-rank test and uni- and multivariate analysis with Cox regression. Results: The overall 5-year survival was 46 %, the 10-year survival 26 % for resected patients. By univariate analysis we could demonstrate that lymph node metastasis is the only predictor for outcome. In the multivariate analysis, age, sex, grading and especially lymph node status were a significant predictor for the survival of patients. Conclusion: In the current patient cohort lymph node status was the most important independent predictor of outcome after resection of carcinoma of Vaterʼs papilla.

Schlüsselwörter

Papillenkarzinom - Langzeitüberleben - Prognosefaktoren - Duodenopankreatektomie - Pankreatogastrostomie

Key words

carcinoma of Vaterʼs papilla - long-term survival - prognostic factors - duodenopancreatectomy - pancreatogastrostomy

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