Effects of Pancreatic Fistula After Minimally Invasive and Open Pancreatoduodenectomy.

IF 15.7 1区 医学 Q1 SURGERY
Caro L Bruna, Anouk M L H Emmen, Kongyuan Wei, Robert P Sutcliffe, Baiyong Shen, Guiseppe K Fusai, Yi-Ming Shyr, Igor Khatkov, Steve White, Leia R Jones, Alberto Manzoni, Mustafa Kerem, Bas Groot Koerkamp, Clarissa Ferrari, Olivier Saint-Marc, I Quintus Molenaar, Claudio Bnà, Safi Dokmak, Ugo Boggi, Rong Liu, Jin-Young Jang, Marc G Besselink, Mohammad Abu Hilal
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引用次数: 0

Abstract

Importance: Postoperative pancreatic fistulas (POPF) are the biggest contributor to surgical morbidity and mortality after pancreatoduodenectomy. The impact of POPF could be influenced by the surgical approach.

Objective: To assess the clinical impact of POPF in patients undergoing minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD).

Design, setting, and participants: This cohort study was conducted from 2007 to 2020 in 36 referral centers in Europe, South America, and Asia. Participants were patients with POPF (grade B/C as defined by the International Study Group of Pancreatic Surgery [ISGPS]) after MIPD and OPD (MIPD-POPF, OPD-POPF). Propensity score matching was performed in a 1:1 ratio based on the variables age (continuous), sex, body mass index (continuous), American Society of Anesthesiologists score (dichotomous), vascular involvement, neoadjuvant therapy, tumor size, malignancy, and POPF grade C. Data analysis was performed from July to October 2023.

Exposure: MIPD and OPD.

Main outcomes and measures: The primary outcome was the presence of a second clinically relevant (ISGPS grade B/C) complication (postpancreatic hemorrhage [PPH], delayed gastric emptying [DGE], bile leak, and chyle leak) besides POPF.

Results: Overall, 1130 patients with POPF were included (558 MIPD and 572 OPD), of whom 336 patients after MIPD were matched to 336 patients after OPD. The median (IQR) age was 65 (58-73) years; there were 703 males (62.2%) and 427 females (37.8%). Among patients who had MIPD-POPF, 129 patients (55%) experienced a second complication compared with 95 patients (36%) with OPD-POPF (P < .001). The rate of PPH was higher with MIPD-POPF (71 patients [21%] vs 22 patients [8.0%]; P < .001), without significant differences for DGE (65 patients [19%] vs 45 patients [16%]; P = .40), bile leak (43 patients [13%] vs 52 patients [19%]; P = .06), and chyle leak (1 patient [0.5%] vs 5 patients [1.9%]; P = .39). MIPD-POPF was associated with a longer hospital stay (median [IQR], 27 [18-38] days vs 22 [15-30] days; P < .001) and more reoperations (67 patients [21%] vs 21 patients [7%]; P < .001) but comparable in-hospital/30-day mortality (25 patients [7%] vs 7 patients [5%]; P = .31) with OPD-POPF, respectively.

Conclusions and relevance: This study found that for patients after MIPD, the presence of POPF is more frequently associated with other clinically relevant complications compared with OPD. This underscores the importance of perioperative mitigation strategies for POPF and the resulting PPH in high-risk patients.

微创胰十二指肠切除术后胰瘘的治疗效果。
重要性:术后胰瘘(POPF)是胰十二指肠切除术后手术发病率和死亡率的最大因素。POPF的影响可能受手术入路的影响。目的:评价POPF在微创胰十二指肠切除术(MIPD)和开放式胰十二指肠切除术(OPD)患者中的临床应用效果。设计、环境和参与者:本队列研究于2007年至2020年在欧洲、南美和亚洲的36个转诊中心进行。参与者是在MIPD和OPD (MIPD-POPF, OPD-POPF)后出现POPF(国际胰腺外科研究小组[ISGPS]定义的B/C级)的患者。根据年龄(连续)、性别、体重指数(连续)、美国麻醉医师学会评分(二分类)、血管受损伤、新辅助治疗、肿瘤大小、恶性程度和POPF c级等变量按1:1的比例进行倾向评分匹配。数据分析时间为2023年7月至10月。暴露:MIPD和OPD。主要结局和指标:主要结局是除POPF外,是否存在第二个临床相关(ISGPS分级B/C)并发症(胰后出血[PPH]、胃排空延迟[DGE]、胆漏和乳糜漏)。结果:总共纳入1130例POPF患者(558例MIPD和572例OPD),其中336例MIPD后患者与336例OPD后患者相匹配。中位(IQR)年龄为65(58-73)岁;男性703人(62.2%),女性427人(37.8%)。在MIPD-POPF患者中,129例患者(55%)出现第二次并发症,而OPD-POPF患者为95例(36%)(P)。结论和相关性:本研究发现,与OPD相比,MIPD后患者中,POPF的存在更频繁地与其他临床相关并发症相关。这强调了高危患者围手术期缓解POPF和由此产生的PPH策略的重要性。
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来源期刊
JAMA surgery
JAMA surgery SURGERY-
CiteScore
20.80
自引率
3.60%
发文量
400
期刊介绍: JAMA Surgery, an international peer-reviewed journal established in 1920, is the official publication of the Association of VA Surgeons, the Pacific Coast Surgical Association, and the Surgical Outcomes Club.It is a proud member of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications.
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