胰十二指肠切除术是治疗胰腺和壶腹周围区域癌症的唯一方法，但具有相当大的手术并发症和不确定的预后。我们的目标是分析时间上的改善，并为胰十二指肠切除术后的结果提供基于当代人群的基准。我们纳入了一个队列，其中包括 1964 年至 2016 年接受胰十二指肠切除术治疗的瑞典所有胰腺癌或壶腹周围癌患者，并在 2016 年实现了完整的随访。分析了术后死亡和疾病特异性净生存率。我们分析了 5923 名患有胰腺癌 (3876)、十二指肠癌 (444)、胆管癌 (504) 或十二指肠乳头癌 (963) 的患者，他们接受了经典 (3332) 或改良 (1652) 治疗) Whipple 手术或全胰腺切除术 (803)。术后死亡率从 20 世纪 60 年代的 17.2% 下降到当代（2010-2016 年）的 1.6%。对于所有四种癌症类型，中位生存率、1 年生存率和 5 年生存率随着时间的推移显着改善。在 2010 年至 2016 年间接受手术的患者中，胰腺癌的 5 年生存率为 29.0%（95% 置信区间 (CI)：25.5, 33.0），十二指肠癌的 5 年生存率为 71.2%（95% CI：62.9, 80.5），30.8%（胆管癌的 95% CI: 23.0, 41.3)，十二指肠乳头癌的 62.7% (95% CI: 55.5, 70.8)。癌症胰十二指肠切除术后的获益-危害比持续显着改善。© 2024 . 作者。

Pancreatoduodenectomy is the only cure for cancers of the pancreas and the periampullary region but has considerable operative complications and uncertain prognosis. Our goal was to analyse temporal improvements and provide contemporary population-based benchmarks for outcomes following pancreatoduodenectomy.We empanelled a cohort comprising all patients in Sweden with pancreatic or periampullary cancer treated with pancreatoduodenectomy from 1964 to 2016 and achieved complete follow-up through 2016. We analysed postoperative deaths and disease-specific net survival.We analysed 5923 patients with cancer of the pancreas (3876), duodenum (444), bile duct (504), or duodenal papilla (963) who underwent classic (3332) or modified (1652) Whipple's procedure or total pancreatectomy (803). Postoperative deaths declined from 17.2% in the 1960s to 1.6% in the contemporary time period (2010-2016). For all four cancer types, median, 1-year and 5-year survival improved substantially over time. Among patients operated between 2010 and 2016, 5-year survival was 29.0% (95% confidence interval (CI): 25.5, 33.0) for pancreatic cancer, 71.2% (95% CI: 62.9, 80.5) for duodenal cancer, 30.8% (95% CI: 23.0, 41.3) for bile duct cancer, and 62.7% (95% CI: 55.5, 70.8) for duodenal papilla cancer.There is a continuous and substantial improvement in the benefit-harm ratio after pancreatoduodenectomy for cancer.© 2024. The Author(s).