接受微创胰腺远端切除术的肥胖患者转为开放手术：多中心分析结果

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-09-01 DOI:10.1016/j.hpb.2024.05.016

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引用次数: 0

摘要

尽管微创远端胰腺切除术（MIDP）被认为是一种标准方法，但仍有不可忽视的转为开放手术的比例，这主要与一些困难因素有关。肥胖患者的微创胰腺手术是一项重大挑战。本研究旨在分析肥胖患者微创胰腺手术的术前相关因素。在这项多中心研究中，纳入了 2012 年至 2022 年期间在 18 个国际专家中心因任何适应症接受 MIDP 的所有肥胖患者。研究收集了基线变量、术前特征、术中和短期结果。分析了与转为开放手术相关的术前因素。在分析的436名患者中，91人（20.9%）接受了开腹手术；这类患者失血量更高、邻近器官切除和血管切除的发生率更高。转为开腹手术与失血量增加、手术时间延长和主要并发症发生率相似有关。在 91 例患者中，有 20 例（22%）患者接受了紧急转院治疗：这些患者术后短期疗效较差。在单变量分析中，微创方法的类型、邻近器官的放射学侵犯、术前淋巴结肿大和 ASA ≥ III 与转为开放手术显著相关。在多变量分析中，机器人方法与腹腔镜方法相比，转换率明显较低（14.6% vs 27.3%，OR = 2.380，P = 0.001）。ASA≥III（OR=2.391，P=0.002）和术前淋巴结肿大（OR=3.836，P=0.003）也与转归有独立关系。在接受 MIDP 的肥胖患者中，接受机器人方法的患者的转归率明显较低。放射学淋巴结肿大和 ASA ≥ III 也与转为开腹手术有关。转为开腹手术与较差的围手术期预后有关，尤其是在术中出血的情况下。因此，对于高危患者，应考虑适当选择手术方式并尽早转为开放手术。

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Conversion to open surgery in obese patients undergoing minimally invasive distal pancreatectomy: results from a multicenter analysis

Background

Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP.

Methods

In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed.

Results

Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion.

Conclusion

Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).