title: Pancreas-sparing duodenectomy with regional lymph node dissection for early-stage ampullary carcinoma: A case control study using propensity scoring methods.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Yong-Jiu
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Sheng-Yi
authors.initials: SY
authors.lastname: You
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Wan-Yee
authors.initials: WY
authors.lastname: Lau
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Hao-Ran
authors.initials: HR
authors.lastname: Sun
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Shi-Yan
authors.initials: SY
authors.lastname: Yan
authors.affiliation: Bin Liu, Zhi-Qiang Wang, Department of Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ampullary carcinoma; Early stage; Prognosis; Propensity scoring methods; Surgical treatments