胰瘘对胰腺导管腺癌前期胰十二指肠切除术后存活率的影响:多中心回顾性研究。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae125
Fanny Castanet, Jeanne Dembinski, Bastien Cabarrou, Jonathan Garnier, Christophe Laurent, Nicolas Regenet, Antonio Sa Cunha, Charlotte Maulat, Laurence Chiche, Gabriella Pittau, Nicolas Carrère, Jean-Marc Regimbeau, Olivier Turrini, Alain Sauvanet, Fabrice Muscari
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引用次数: 0

摘要

背景:术后胰瘘对生存率的影响仍存在争议。本研究旨在评估术后胰瘘对胰腺导管腺癌先期胰十二指肠切除术后总生存率和无复发生存率的影响:研究纳入了2007年1月至2017年12月期间在7家三级胰腺中心接受胰腺导管腺癌手术的患者。术后胰瘘采用2016年国际胰腺外科研究小组分级系统进行定义。通过单变量和多变量分析研究了术后胰瘘对总生存期、无复发生存期(不包括术后90天死亡)和相应风险因素的影响。对于分类变量,采用卡方检验或费雪精确检验进行组间比较;对于连续变量,采用曼-惠特尼U检验进行组间比较。比值比及其 95% 置信区间均已估算。采用卡普兰-梅耶法计算存活率及其95%置信区间:结果:2007年至2017年间共纳入819例患者。14.4%的患者(n = 118)发生了术后胰瘘;其中,B级和C级术后胰瘘分别占7.8%(n = 64)和6.6%(n = 54)。非术后胰瘘组的5年总生存率为37.0%,术后胰瘘组为45.3%(P = 0.127)。术后C级胰瘘(不包括术后90天死亡病例)不是总生存率的预后因素。无术后胰瘘患者的5年无复发生存率为26.0%,有术后胰瘘患者的5年无复发生存率为43.7%(P = 0.003)。确定了无复发生存率的八个独立预后因素:年龄超过70岁、糖尿病、肿瘤分化程度中度或较差、肿瘤分期T3/T4、淋巴结阳性、切除边缘R1、血管栓塞和神经周围侵犯:这一高容量队列显示,根据2016年国际胰腺外科研究小组分级系统,C级术后胰瘘不会影响总生存率或无复发生存率(不包括术后90天死亡)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Influence of pancreatic fistula on survival after upfront pancreatoduodenectomy for pancreatic ductal adenocarcinoma: multicentre retrospective study.

Background: The effects of postoperative pancreatic fistula on survival rates remain controversial. The aim of the present study was to evaluate the influence of postoperative pancreatic fistula on overall survival and recurrence-free survival after upfront pancreatoduodenectomy for pancreatic ductal adenocarcinoma.

Methods: Patients operated on between January 2007 and December 2017 at seven tertiary pancreatic centres for pancreatic ductal adenocarcinoma were included in the study. Postoperative pancreatic fistula was defined using the 2016 International Study Group on Pancreatic Surgery grading system. The impact of postoperative pancreatic fistula on overall survival, recurrence-free survival (excluding 90-day postoperative deaths) and corresponding risk factors were investigated by univariable and multivariable analyses. Comparisons between groups were made using the chi-squared or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. Odds ratios were estimated with their 95% confidence intervals. Survival rates were calculated using the Kaplan-Meier method with their 95% confidence intervals.

Results: A total of 819 patients were included between 2007 and 2017. Postoperative pancreatic fistula occurred in 14.4% (n = 118) of patients; of those, 7.8% (n = 64) and 6.6% (n = 54) accounted for grade B and grade C postoperative pancreatic fistula respectively. The 5-year overall survival was 37.0% in the non-postoperative pancreatic fistula group and 45.3% in the postoperative pancreatic fistula cohort (P = 0.127). Grade C postoperative pancreatic fistula (excluding 90-day postoperative deaths) was not a prognostic factor for overall survival. The 5-year recurrence-free survival was 26.0% for patients without postoperative pancreatic fistula and 43.7% for patients with postoperative pancreatic fistula (P = 0.003). Eight independent prognostic factors for recurrence-free survival were identified: age over 70 years, diabetes, moderate or poor tumour differentiation, T3/T4 tumour stage, lymph node positive status, resection margins R1, vascular emboli and perineural invasion.

Conclusion: This high-volume cohort showed that grade C postoperative pancreatic fistula, based on the 2016 International Study Group on Pancreatic Surgery grading system, does not impact overall or recurrence-free survival (excluding 90-day postoperative deaths).

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
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144
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