Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L Teichman, Christopher Bargoud, Jason D Sciarretta, Randi N Smith, Dustin Hanos, Iman N Afif, Jessica H Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A Smith, Brandi Sun, Chloe S Cao, Jessica K Reynolds, Lauren A Hilt, Daniel N Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S Fung, Aaron Anderson, Caitlin A Fitzgerald, Ryan Peter Dumas, Jeremy H Levin, Christine T Trankiem, JaeHee Yoon, Jacqueline Blank, Joshua P Hazelton, Christopher J McLaughlin, Rami Al-Aref, Jordan Michael Kirsch, Daniel S Howard, Dane R Scantling, Kate Dellonte, Michael A Vella, Brent Hopkins, Chloe Shell, Pascal Udekwu, Evan G Wong, Bellal Joseph, Howard Lieberman, Walter A Ramsey, Collin H Stewart, Claudia Alvarez, John D Berne, Jeffry Nahmias, Ivan Puente, Joe Patton, Ilya Rakitin, Lindsey Perea, Odessa Pulido, Hashim Ahmed, Jane Keating, Lisa M Kodadek, Jason Wade, Henry Reynold, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher W Foote, Carlos H Palacio, Dias Argandykov, Haytham Kaafarani, Michelle T Bover Manderski, Lilamarie Moko, Mayur Narayan, Mark Seamon
{"title":"IV-V级十二指肠或胰腺损伤的创伤患者行胰十二指肠切除术：一项EAST多中心试验的事后分析","authors":"Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L Teichman, Christopher Bargoud, Jason D Sciarretta, Randi N Smith, Dustin Hanos, Iman N Afif, Jessica H Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A Smith, Brandi Sun, Chloe S Cao, Jessica K Reynolds, Lauren A Hilt, Daniel N Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S Fung, Aaron Anderson, Caitlin A Fitzgerald, Ryan Peter Dumas, Jeremy H Levin, Christine T Trankiem, JaeHee Yoon, Jacqueline Blank, Joshua P Hazelton, Christopher J McLaughlin, Rami Al-Aref, Jordan Michael Kirsch, Daniel S Howard, Dane R Scantling, Kate Dellonte, Michael A Vella, Brent Hopkins, Chloe Shell, Pascal Udekwu, Evan G Wong, Bellal Joseph, Howard Lieberman, Walter A Ramsey, Collin H Stewart, Claudia Alvarez, John D Berne, Jeffry Nahmias, Ivan Puente, Joe Patton, Ilya Rakitin, Lindsey Perea, Odessa Pulido, Hashim Ahmed, Jane Keating, Lisa M Kodadek, Jason Wade, Henry Reynold, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher W Foote, Carlos H Palacio, Dias Argandykov, Haytham Kaafarani, Michelle T Bover Manderski, Lilamarie Moko, Mayur Narayan, Mark Seamon","doi":"10.1136/tsaco-2024-001438","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.</p><p><strong>Methods: </strong>This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.</p><p><strong>Results: </strong>The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p<i>=</i>0.028).</p><p><strong>Conclusion: </strong>While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management.</p><p><strong>Level of evidence: </strong>IV, Multicenter retrospective comparative study.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001438"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664373/pdf/","citationCount":"0","resultStr":"{\"title\":\"Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.\",\"authors\":\"Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L Teichman, Christopher Bargoud, Jason D Sciarretta, Randi N Smith, Dustin Hanos, Iman N Afif, Jessica H Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A Smith, Brandi Sun, Chloe S Cao, Jessica K Reynolds, Lauren A Hilt, Daniel N Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S Fung, Aaron Anderson, Caitlin A Fitzgerald, Ryan Peter Dumas, Jeremy H Levin, Christine T Trankiem, JaeHee Yoon, Jacqueline Blank, Joshua P Hazelton, Christopher J McLaughlin, Rami Al-Aref, Jordan Michael Kirsch, Daniel S Howard, Dane R Scantling, Kate Dellonte, Michael A Vella, Brent Hopkins, Chloe Shell, Pascal Udekwu, Evan G Wong, Bellal Joseph, Howard Lieberman, Walter A Ramsey, Collin H Stewart, Claudia Alvarez, John D Berne, Jeffry Nahmias, Ivan Puente, Joe Patton, Ilya Rakitin, Lindsey Perea, Odessa Pulido, Hashim Ahmed, Jane Keating, Lisa M Kodadek, Jason Wade, Henry Reynold, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher W Foote, Carlos H Palacio, Dias Argandykov, Haytham Kaafarani, Michelle T Bover Manderski, Lilamarie Moko, Mayur Narayan, Mark Seamon\",\"doi\":\"10.1136/tsaco-2024-001438\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.</p><p><strong>Methods: </strong>This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.</p><p><strong>Results: </strong>The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p<i>=</i>0.028).</p><p><strong>Conclusion: </strong>While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management.</p><p><strong>Level of evidence: </strong>IV, Multicenter retrospective comparative study.</p>\",\"PeriodicalId\":23307,\"journal\":{\"name\":\"Trauma Surgery & Acute Care Open\",\"volume\":\"9 1\",\"pages\":\"e001438\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-12-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664373/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Trauma Surgery & Acute Care Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/tsaco-2024-001438\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Trauma Surgery & Acute Care Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/tsaco-2024-001438","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.
Introduction: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.
Methods: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.
Results: The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028).
Conclusion: While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management.
Level of evidence: IV, Multicenter retrospective comparative study.
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