Radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection in pancreatic head cancer

Background Recent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior, which is characterized by neural infiltration. This study aimed to investigate the clinical significance of radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection for carcinoma of the pancreatic head.
Methods Forty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005. The patients were divided into two groups： radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection （group A, n=25） and routine Whipple＇s operation （group B, n=-21）. There were no significant differences between the two groups in relation to age, gender and preoperative risk factors, and perioperative conditions, patholoclical data and survival rates were studied.
Results There were no significant differences in tumor size, surgical procedure time, postoperative complications, and time of hospitalization. However, the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B （P〈0.05）. The 1- and 3-year survival rate in group A were 80% and 53%, respectively, which was higher than those in group B （P〈0.05）. There were significant differences in the survival rates between patients with and without nerve infiltration in group A （P〈0.05）.
Conclusions Radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection, can effectively remove the lymph and nerve tissues that were infiltrated by tumor. Meanwhile, this method can reduce the local recurrence rate so as to improve the long-term survival of patients.     

Preoperative prediction of survival in resectable gallbladder cancer by a combined utilization of CA 19-9 and carcinoembryonic antigen

Background Currently,all frequently used staging systems in gallbladder cancer （GBC） are based on postoperative pathological examinations.In patients undergoing curative operation,there is no effective method to predict survival preoperatively.In this study,we explored whether a combined utilization of two tumor biomarkers,namely carbohydrate antigen 19-9 （CA 19-9） and carcinoembryonic antigen （CEA）,could give a preoperative prediction of survival in resectable GBC.Methods Seventy-three patients who underwent radical resection for GBC were included in this study.A retrospective analysis of clinical-pathological data was conducted.Results By multivariate analysis,CA 19-9 elevation （P ＜0.05） and CEA elevation （P ＜0.001） were discovered as two individual factors for postoperative survival.By a combined utilization,patients were divided into three groups：patients with elevation of CEA （group Ⅰ）,patients with elevation of CA 19-9 but without CEA （group Ⅱ）,and patients with nonelevations of either CA 19-9 or CEA （group Ⅲ）.The cumulative 5-year survival rates in groups Ⅰ,Ⅱ,and Ⅲ were 0,14.0％,and 42.8％,respectively （P ＜0.05）.Conclusions By a combined utilization of CA 19-9 and CEA,individualized prediction of survival is available in resectable GBC before operation.Extended radical operation brings the most prognostic benefits in patients with nonelevations of either CA 19-9 or CEA.However,if operation would be in a larger-scale destructive manner,careful consideration of surgical decisions should be made in patients with elevation of tumor biomarkers,especially CEA.     

Multimodality therapy including surgical resection for limited small cell lung cancer.

From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department. The median postoperative survival time of the 199 patients was 39 months, and the 5-year survival rate was 26%, which was decreased with increase of tumor-stage. In comparison of the survival time of patients in Stage Ⅰ and those in Stage Ⅲa, there was a significant difference (P<0.01). There were no significant differences in survival rate of 3 and 5 years between the patients receiving chemotherapy prior to or after surgical resection. The improvement in survival was documented by surgical resection combined with chemotherapy or chemoradiotherapy for LSCLC. The effect of multimodality treatment is correlated with tumor P-TNM staging, the involvement of lymph node, especially that of the mediastinal lymph node, is a negative factor influencing the prognosis. Surgical resection as an ini     

Surgical selection for late pancreatic head carcinoma without gastric outlet obstruction

The effects of different surgical procedures for late pancreatic head carcinoma without gas- tric outlet obstruction were explored in order to provide theoretical basis to select a suitable operation for these patients. The clinical data of 441 cases of late pancreatic head carcinoma without gastric outlet obstruction were retrospectively analyzed. All patients were divided into 4 groups based on different surgical procedures： group A （101 cases） subjected to Roux-en-Y cholecystojejunostomy; group B （133 cases） undergoing Roux-en-Y choledochojejunostomy; group C （83 cases） given Roux-en-Y chole- cystojejunostomy combined with gastrojejunostomy; group D （124 cases） receiving Roux-en-Y chole- dochojejunostomy combined with gastrojejunostomy. Therapeutic efficacy in each group was evaluated comparatively. Both groups B and D had a lower rate of postoperative obstructive jaundice than groups A and C separately （P〈0.05 for all）. The data of mean life span showed that both groups B and D had a lower survival rate than groups A and C separately （P〈0.05 for all）. The incidence of postoperative gas- tric outlet obstruction in groups A and B was higher than that in groups C and D separately （P〈0.05 for all）. The gastrojejunostomy had no impacts on the mean life span, and there was no statistically signifi- cant difference in complications, average hospital stay （days） and median survival among four groups （P〉0.05）. For the late pancreatic head carcinoma without gastric outlet obstruction, Roux-en-~ chole- dochojejunostomy is effective for the reduction of icteric index and the incidence of recurrent jaundice, also offers an opportunity for prolonged survival. Combined use of prophylactic Roux-en-Y gastrojeju- nostomy during surgical biliary drainage is safe for advanced pancreatic carcinoma with obstructive jaundice, which can decrease the incidence of postoperative gastric outlet obstruction, and has important implications for improving outcomes.     

Chemoradiotherapy followed by surgery could improve the efficacy of treatments in patients with resectable esophageal carcinoma

Background The effectiveness of chemoradiotherapy followed by surgery （CRTS） in patients with resectable esophageal carcinoma remains controversial.We performed a systematic review of the literature with meta-analysis.Methods Electronic databases were used to identify published studies between January 1992 and April 2012.Pooled relative risk （RR） with 95％ confidence interval （95％ CI） was utilized to estimate the strength of the association between CRTS and surgery alone （SA） survival of the resectable esophageal carcinoma patients.Heterogeneity and publication bias were also assessed in the present study.Results The final analysis of 2755 resectable esophageal carcinoma cases from 21 randomized controlled trials （RCTs） are presented.Compared to the SA group,the 1,3-and 5-year survival rates were significantly higher in the CRTS group （all P ＜0.05）; the 3-and 5-year survival rates for the Eastern patients,Western patients,patients undergoing concurrent chemoradiotherapy,patients with squamous cell carcinoma,patients undergoing High-dose radiotherapy （≥40 Gy）,and patients given either ＂cisplatin ＋ Fluorouracil＂ or ＂cisplatin ＋ paclitaxel＂ chemotherapy were significantly higher in the CRTS group （all P ＜0.05）.There were no statistical significances in the 3-and 5-year survival rates for patients undergoing sequential chemoradiotherapy or patients with adenocarcinoma between the two groups （all P ＞0.05）.Compared to the RCTS group,the surgery rate in the SA group was higher （P ＜0.05）,while the CRTS group had significantly higher radical resection rate,R0 resection rate and lower postoperative local recurrence rate （all P ＜0.05）.The differences in postoperative complication incidence,post-operative distant metastasis and postoperative mortality rate were not statistically significant between the two groups （all P ＞0.05）.Conclusion CRTS can significantly improve the survival and surgical conditions of patients with resectable esophageal carcinoma.     

Jaundice as a prognostic factor in patients undergoing radical treatment for carcinomas of the ampulla of Vater

Background Carcinomas of the ampulla of Vater （CAV） is a relatively rare malignant gastrointestinal tumor,and its postoperative prognostic factors have been well studied.However,as its first symptom,the impact of jaundice on the prognosis of CAV is not so clear.This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV.Methods The clinical data of 195 patients with CAV who were treated in the Cancer Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,from January 1989 to January 2013 were retrospectively analyzed.Among them,170 patients with pathologically confirmed CAV entered the statistical analysis.Jaundice was defined as a total bilirubin serum concentration of ≥3 mg/dl.Result Of these 170 patients,99 （58.20％） had jaundice at presentation.Jaundice showed significant correlations with tumor differentiation （P=0.002）,lymph node metastasis （P=0.016）,pancreatic invasion （P=0.000）,elevated preoperative CA199 （P=0.000）,depth of invasion （P=0.000）,and tumor stage （P=0.000）.There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group.Also,lymph node metastasis was more common in the jaundice group （n=26） than in the non-jaundice group （n=8）.The non-jaundice group had significant better overall 5-year disease-free survival （72.6％） than the jaundice group （41.2％,P=0.013）.Jaundice was not significantly correlated with the postoperative bleeding （P=-0.050）.Conclusions Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses.Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice.Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.     

Anaplastic carcinoma of pancreas：report of 6 cases and literature review

Objective:To investigate clinicopathological features,diagnosis and treatment of anaplastic carcinoma of the pancreas and to review relevant literature on this entity. Methods..A retrospective clinical analysis was made in 6 cases of anaplastic pancreatic carcinomas admitted from 1989 to 2001. Results:Anaplastic pancreatic carcinoma was found in 5 men and 1 woman with a mean age of 61.5 years. Tumor location was in the head of the pancreas in 3 patients,body and tail in 3 cases. Tumors were surgically resected in all patients, by pancreaticoduodenectomy in 1, by pancreaticoduodenectomy combined resection and reconstruction of superior mesenteric vein (SMV) in 1, by pancreaticoduodenectomy combined resection and reconstruction of SMV and superior mesenteric artery (SMA) in 1,by distal pancreatectomy in 2,by distal pancreatectomy combined total gastrotectomy in 1. Liver metastasis was found in one patient. Follow-up suggested the prognosis was poor with a mean survival of 5.5 months after operation. All patients were dead with tumor recurrence and liver metastasis. Conclusion:Histologically,anaplastic pancreatic carcinoma is characterized by pleomorphic cell carcinoma consisting of pleomorphic giant/small cells and spindle cells,or osteoclast-like giant cell tumor composed of pleomorphic small cells,or pleomorphic giant cell carcinoma with osteoclastoid giant cells,and demonstrates aggressive biological behavior. Invasions to adjoined organ and metastasis are usual. The prognosis of this tumor appears to be very poor.     

Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery （LVRS） can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms. Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups. Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO2, PaCO2, dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B. Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded the surgical indication for tumor patients.     

Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases

Background Hepatectomy is a standard hepatic surgica line with improvements in surgical techniques. This study with hepatectomy. technique. The safety of hepatectomy has been improved in analyzed the operative and perioperative factors associated Methods A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings. Results Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively, of the conditions requiring resections. Primary liver cancers accounted for 76.1% of the malignant tumors, while hilar cholangiocarcinomas accounted for 6.7%. Hemangiomas （41.7%） and hepatolithiasis （29.6%） were the most common of the benign conditions. Microwave in-line coagulation was used in 236 of our liver resection cases. The overall postoperative complication rate was 14.44%, of which 12.54% of resections were performed for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. The overall hospital mortality was 0.55%, and that for malignant liver disease was 0.51%. A high mortality （2.53%） was associated with extensive liver resections for hilar cholangiocarcinomas （two deaths in 79 cases）. Microwave in-line pre-coagulation resection, Child-Pugh grading, operating time, postoperative length of stay, and preoperative serum albumin level were independent predictors of morbidity. Blood loss, Child-Pugh grading, operating time and preoperative serum albumin level were independent predictors of mortality. Conclusions Hepatectomy can be performed safely with low morbidity and mortality, provided that it is carried out with optimal perioperative management and innovative surgical techniques.     

Surgical intervention for advanced valvular heart disease in 227 cases

Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Methods From January 1994 to October 2003, surgical procedures of heart valve replacement were performed on 227 (136 men and 91 women) patients with AVHD in our Department of Cardiothoracic Surgery. The clinical data of all patients were collected and analysed. Patients’ age ranged from 10 years to 77 years. In preoperative cardiac function grading, 157 cases were NYHA III and 70 cases NYHA IV. Fifty-one patients had had cardiac operations. The ultrasonic cardiac graphs showed that 145 patients suffered from moderate or severe pulmonary hypertension and 73 had combined giant left ventricle. Mitral valve replacement was performed in 32 cases, aortic valve replacement in 90, tricuspid valve replacement in 1, combined mitral and aortic replacement in 103 and combined mitral and tricuspid replacement in 1. Nineteen patients also received surgical corrections for other minor abnormalities during the operations. A logistic model was established to evaluate the influence of perioperative factors on the mortality rate. Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976. Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.     

新辅助化疗对结直肠癌肝脏转移瘤肝切除术后的影响

目的探讨新辅助化疗对结直肠癌肝脏转移瘤肝切除术后的影响。方法结直肠癌肝脏转移瘤患者57例,分为术前行新辅助化疗组（A组）23例和直接手术组（B组）34例,对比分析其疗效。结果两组均无手术30 d内死亡病例。其中输血人数、住院天数、胆漏在A组明显高于B组,差异均有统计学意义（均P〈0.05）。呼吸系统并发症、循环系统并发症,两组差异均无统计学意义（均P〉0.05）。1、3、5年生存率A组分别为：83.3%,60.2%,37.5%,而B组分别为84.8%,68.2%,32.5%,两组差异均无统计学意义（均P〉0.05）。结论术前评估肝脏转移瘤可切除的患者,如无明显手术禁忌症可直接手术治疗,这样可减少相应的术后并发症。     

胰头癌扩大切除标本的病理分析

 目的 探讨胰头癌肿瘤细胞的淋巴结转移模式及胰头癌扩大切除术的适用范围。 方法 按日本胰腺协会(Japanese Pancreas Society,JPS)制定的胰腺癌研究通则对126例胰头癌扩大切除标本行淋巴结分组(1~18组)并计数,其中包括3例有肝转移的胰腺癌病例,分析淋巴结各组的转移频率、肿瘤大小、分化程度与淋巴结转移的相关性,淋巴结转移和肝转移间的关系。 结果 126例胰头癌扩大切除标本中88例有淋巴结转移,移频率由高到低排列前3位的依次是13组、14组和17组。15例有16组淋巴结转移的病例中,14例同时伴有13组、14组或17组淋巴结转移,另1例仅有16组淋巴结转移;3例有肝转移的病例不伴有16组淋巴结转移。淋巴结转移率与肿瘤分化程度呈负相关;淋巴结转移率与肿瘤大小及肝脏转移无明显相关性。结论 淋巴结的广泛转移和早期发生远处转移是导致胰腺癌高度恶性的原因,无远处转移的患者才能从胰十二指肠扩大切除术中获益。     

进展期胃癌术前动静脉联合化疗的临床研究

目的胃癌是我国常见恶性肿瘤,早期诊断率低,患者多为进展期,预后不佳。文中旨在研究术前静脉化疗联合动脉灌注化疗治疗进展期胃癌的价值。方法对入选的56例均有病理证实的进展期胃癌患者采用FLEP方案术前静脉联合动脉灌注化疗。第1至第5天5-FU370 mg/m2+亚叶酸钙200 mg/m2,静脉;顺铂80 mg/m2+依托泊苷80 mg/m2,第6天、第20天动脉灌注,2个疗程后行手术切除治疗。结果所有患者均完成2个疗程治疗,总体缓解率为78.57%(44例),其中4例完全缓解(7.14%)。46例接受手术切除,其中21例化疗前被认为不可切除。化疗前评估可切除组的R0(手术切缘阴性)切除率为96.15%(25/26),不可切除组的R0切除率为66.67%(20/30)。8.70%为病理学完全缓解。毒副反应均为较轻常见反应,无化疗药物死亡病例。中位随访时间31个月(6～76月),整组和可切除组的5年生存率分别为21%和42%。结论进展期胃癌术前应用静脉联合动脉灌注化疗是一种有效、安全的治疗方式,能显著提高手术切除率及患者生存期,在进展期胃癌的治疗中起重要作用。     

胰腺癌动脉灌注化疗分析

目的：对24例胰腺癌患者的介入治疗进行总结分析,探讨胰腺癌介入治疗效果。方法：采用seld inger方法穿刺,股动脉插管行胃十二指肠动脉,脾动脉,肠系膜上动脉造影,根据造影表现超选上述动脉经导管灌注药物5-Fu 500-1000mg、键折1.2-1.6g,行胰腺肿瘤供血动脉灌注化疗。对有肝脏转移的病例同时行肝动脉化疗栓塞术。疗程为一个月。结果：全组病例术后疼痛缓解12例,占50%;疼痛无明显变化7例,占29%;疼痛加剧5例,占21%。所有病例两个月内肿瘤大小无明显变化。中位生存期为8.2个月。除2例肝转移患者术后出现呕吐,疼痛外其余患者术后无明显副作用。结论：胰腺癌动脉灌注化疗对改善患者症状、提高生存期疗效明显。     

术前磁共振成像评估壶腹周围癌Whipple手术的价值

目的探讨磁共振成像技术在壶腹周围癌Whipple手术可切除性中的应用价值。方法对178例拟行Whipple手术的壶腹周围癌患者,术前进行1．5T磁共振平扫加增强扫描,明确肿瘤类型以及肿瘤和周围组织之间的关系,并在此基础上进行综合分析,从而对患者Whipple手术可切除性进行术前评估。结果178例壶腹周围癌患者中,胆总管下端癌46例（25．8％）,壶腹癌37例（20．8％）,十二指肠乳头癌7例（3．9％）,胰腺癌88例（49．4％）;磁共振术前诊断淋巴结转移者59例（33．1％）,肝脏转移者17例（9．6％）,血管受累者51例（28．7％）,明显肝内外胆管扩张者127例（71．3％）。178例患者中,通过磁共振检查评估可手术切除者118例,实际切除者112例;不可切除者80例,实际切除者3例。结论壶腹周围癌的术前磁共振检查对术前指导临床进行Whipple手术具有很高的价值。     

联合门静脉/肠系膜上静脉切除重建的胰十二指肠切除术治疗胰腺癌的临床探讨

目的探讨联合门静脉/肠系膜上静脉切除重建的胰十二指肠切除术治疗胰腺癌患者的效果。方法选取2017年3月至2018年9月于本院接受治疗的胰腺癌患者102例并通过随机数字表法分成两组,每组51例。参考组患者采用常规手术切除,观察组患者采用联合门静脉/肠系膜上静脉切除重建的胰十二指肠切除术,比较两组临床指标、术后并发症以及术后生存情况。结果观察组患者术中出血量多于参考组,手术时间、术后住院时间均长于参考组(P<0.05);观察组术后并发症总发生率低于参考组(P<0.05)。术后6个月及术后1年,观察组生存率均高于参考组(P<0.05)。结论胰腺癌患者应用联合门静脉/肠系膜上静脉切除重建胰十二指肠切除术,能提高手术疗效和患者生存率。     

胰腺神经鞘瘤临床诊治分析

目的：探讨胰腺神经鞘瘤的临床特点和诊治方法。方法总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁（范围17～89岁）,其中女性40例（56％）。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6．1 cm （1～20 cm）。肿瘤位于胰头部29例（40％）、胰体／尾部32例（44％）,沟突部6例（8％）。肿瘤表现为实性肿物27例（38％）、囊性28例（39％）、囊实性10例（14％）。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例（7％）患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[（13．8±6．2）cm vs （5．6±4．1）cm,P ＝0．0004）]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。     

胰腺神经内分泌肿瘤肝转移患者手术治疗与非手术治疗的预后分析研究

背景　胰腺神经内分泌肿瘤相对罕见,但在疾病进展过程中可发生局部淋巴结、肝、肺和骨转移,以肝转移最为常见,约有50%患者容易发生肝转移,治疗方式影响患者的生存率,对患者的生命质量有一定的影响。目的　探讨胰腺神经内分泌肿瘤肝转移患者手术治疗对预后的影响,为临床决策提供参考依据。方法　选取2004—2013年SEER数据库中胰腺神经内分泌肿瘤的数据,纳入476例胰腺神经内分泌肿瘤肝转移患者。根据患者是否切除原发性肿瘤,将其分为手术治疗组和非手术治疗组。提取患者基线资料和临床特征,研究的终点是总体生存时间。结果　476例患者中,手术治疗组125例（26.3%）,非手术治疗组351例（73.7%）。手术治疗组生存时间长于非手术治疗组（χ2=57.649,P=0.001）。将患者分别按照T分期、淋巴结转移和组织学分化程度进行分层分析,结果显示,T1、T2、T3期患者中,手术治疗组生存时间均长于非手术治疗组（χ2=5.543,P=0.019;χ2=11.494,P=0.001;χ2=34.240,P<0.001）。有淋巴结转移和无淋巴结转移患者中,手术治疗组生存时间均长于非手术治疗组（χ2=29.392,P<0.001;χ2=30.722,P<0.001）。组织学分化程度Ⅰ~Ⅱ级和Ⅲ~Ⅳ级患者中,手术治疗组生存时间均长于非手术治疗组（χ2=18.513,P<0.001;χ2=11.219,P<0.001）。多因素Cox比例风险回归模型结果显示,年龄>60岁〔HR=1.973,95%CI（1.476,2.637）〕、组织学分化程度为Ⅲ级或Ⅳ级〔HR=3.864,95%CI（2.279,6.551）;HR=2.801,95%CI（1.278,6.141）〕、非手术治疗〔HR=4.845,95%CI（2.853,8.226）〕是胰腺神经内分泌肿瘤肝转移患者预后的独立危险因素（P<0.05）。结论　胰腺神经内分泌肿瘤肝转移患者的手术切除提高了生存率。淋巴结转移和不同T分期与生存率无关,而年龄和组织学分化程度对生存率有显著影响。对于年龄<60岁的胰腺神经内分泌肿瘤肝转移患者,原发性肿瘤切除术应被视为治疗策略。