Extended pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery is associated with worse survival but not with increased morbidity
Extended pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery is associated with worse survival but not with increased morbidity
复制标题
DOI：
10.1016/j.surg.2015.03.015
复制
发表时间：
2015-07-01
期刊：
影响因子：
3.8
通讯作者：
Samra, Jaswinder S.
中科院分区：
文献类型：
--
作者：
De Reuver, Philip R.;Mittal, Anubhav;Samra, Jaswinder S.
背景。最近，国际胰腺外科研究小组就胰管腺癌（PDAC）的扩展胰十二指肠切除术（PD）的定义发表了共识声明。由于扩大切除与发病率和死亡率增加有关，预后因素是优化患者选择的强制性因素。本研究的目的是应用扩展PD的新定义，并评估pdac患者的短期并发症和生存的预后因素。对2004年至2014年前瞻性收集的数据库进行回顾性分析。纳入标准均为组织病理学证实为PDAC的PD切除术。分析临床资料、手术结果及近期和长期预后。在这项研究中，我们纳入了177例因PDAC接受PD治疗的患者。66例（37%）患者接受了标准PD， 111例（63%）患者接受了扩展PD。术后住院时间（中位数为13天）和总并发症发生率（n = 61）均无差异。严重并发症24例（13%）。男性（优势比，2.4;95% CI, 0.9-6.6）是严重并发症的预后因素。两组均无住院死亡率或90天死亡率。多因素生存分析显示，肿瘤分化差（危险比[HR]， 2.0; 95% CI, 1.3-3.1）、淋巴结转移（危险比[HR]， 2.3; 95% CI, 1.4-3.9）、神经侵犯（危险比[HR]， 1.9; 95% CI, 1.2-3.1）是预后差的独立因素。延长切除与较差的生存率相关，但不是一个独立的预后因素（HR, 1.5; 95% CI, 1.0-2.3）。延长PD与较差的生存率相关，但与发病率增加无关。
Background. Recently, the International Study Group for Pancreatic Surgery presented a consensus statement on the definition of an extended pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Because extended resections are associated with increased morbidity and mortality, prognostic factors for outcome are mandatory to optimize patient selection. The aim of this study was to apply the new definition of an extended PD and to assess prognostic factors for short-term complications and survival in patients with PDAC.Methods. A retrospective analysis was performed on a prospectively collected database running from 2004 to 2014. Inclusion criteria were all PD resections with histopathology-proven PDAC. Clinical data, operative results, and short- and long-term outcomes were analyzed.Results. We included 177 patients who underwent PD for PDAC in this study. Sixty-six patients (37%) underwent a standard PD and 111 (63%) underwent an extended PD. No differences were found in duration of postoperative stay (median, 13 days) or overall complication rate of 35% (n = 61). Severe complications occurred in 24 patients (13%). Male sex (odds ratio, 2.4; 95% CI, 0.9-6.6) was a prognostic factor for severe complications. There was no in-hospital or 90-day mortality in either group. Multivariate survival analysis showed that poor tumor differentiation (hazard ratio [HR], 2.0; 95% CI, 1.3-3.1), lymph node metastasis (HR, 2.3; 95% CI, 1.4-3.9), neural invasion (HR, 1.9; 95% CI, 1.2-3.1), were independent prognostic factors for worse survival. An extended resection was associated with worse survival, but was not an independent prognostic factor (HR, 1.5; 95% CI, 1.0-2.3).Conclusion. Extended PD is associated with worse survival but not with increased morbidity.