Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association
Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association
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DOI：
10.1111/hpb.12063
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发表时间：
2014-01-01
期刊：
影响因子：
2.9
通讯作者：
Bachellier, Philippe
中科院分区：
文献类型：
--
作者：
Addeo, Pietro;Delpero, Jean Robert;Bachellier, Philippe
背景胰瘘（PF）是胰管切除术（PD）后最常见的并发症。这一回顾性多中心研究试图阐明的危险因素和并发症的PF在一个大的队列的患者进行PD导管adenocarcinoma.MethodsUsing一项调查工具，1325例患者进行PD导管腺癌在37个机构，2004年1月至2009年12月，收集的临床数据。评估与PF相关的围手术期风险因素及其与发病率和死亡率的相关性。根据ISGPF（国际研究组胰瘘）的定义和Dindo-Clavien classification.ResultsOverall PF，死亡率，发病率和再剖腹手术率分别为14.3%，3.8%，54.4%和11.7%。与胰胃吻合术（PG）相比，胰肠吻合术（PJ）后PF的发生率更高（16.8% vs. 10.4%; P = 0.0012）。多因素分析显示，PF的独立危险因素为术前无糖尿病（P = 0.0014）、PJ重建（P = 0.0035）、胰腺软组织（P < 0.0001）和低容量中心（P = 0.0286）。PJ后临床相关PF（B和C级）和严重并发症（Dindo-Clavien IIIB、IV、V级）的发生率显著高于PG（分别为71.6% vs. 28.3%; P = 0.030和24.8% vs. 19.1%; P = 0.015）。PG和PJ.ConclusionsA软胰腺实质，没有术前糖尿病，PJ和低容量中心后，PD导管腺癌PF的独立危险因素的总体死亡率和再剖腹产率相似。PF的发生率和临床严重程度明显高于PJ。
BackgroundsA pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma.MethodsUsing a survey tool, clinical data of 1325 patients undergoing a PD for ductal adenocarcinoma at 37 institutions, between January 2004 and December 2009, were collected. Peri-operative risk factors associated with PF and its association with morbidity and mortality were assessed. Morbidity and PF were graded according to the ISGPF (International Study group for pancreatic fistula) definition and the Dindo-Clavien classification.ResultsOverall PF, mortality, morbidity and relaparotomy rates were 14.3%, 3.8%, 54.4% and 11.7%, respectively. PF occurred more frequently after a pancreaticojejunostomy (PJ) compared with a pancreaticogastrostomy (PG) (16.8% vs. 10.4%; P = 0.0012). Independent risk factors for PF by multivariate analysis were absence of pre-operative diabetes (P = 0.0014), PJ reconstruction (P = 0.0035), soft pancreatic parenchyma (P < 0.0001) and low-volume centre (P = 0.0286). Clinically relevant PF (grade B and C) and severe complications (Dindo-Clavien grade IIIB, IV, V) were significantly more frequent after PJ than PG (71.6% vs. 28.3%; P = 0.030 and 24.8% vs. 19.1%; P = 0.015, respectively). Overall mortality and relaparotomy rates were similar after PG and PJ.ConclusionsA soft pancreatic parenchyma, the absence of pre-operative diabetes, PJ and low-volume centre are independent risk factors for PF after PD for ductal adenocarcinoma. A significantly higher incidence and clinical severity of PF are associated with PJ.