The Impact of Vascular Resection on Early Postoperative Outcomes after Pancreaticoduodenectomy: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database
The Impact of Vascular Resection on Early Postoperative Outcomes after Pancreaticoduodenectomy: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database
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DOI：
10.1245/s10434-012-2585-y
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发表时间：
2012-12-01
影响因子：
3.7
通讯作者：
Scarborough, John E.
中科院分区：
文献类型：
--
作者：
Castleberry, Anthony W.;White, Rebekah R.;Scarborough, John E.
一些单中心报告表明，胰腺癌患者在胰腺切除术（PD）期间进行血管切除（VR）是可行的，不会影响术后早期死亡率或发病率。我们的目的是使用2005-2009年国家手术质量改进计划参与者用户文件进行回顾性队列分析，使用大型多中心数据源回顾PD期间VR的相关结局。纳入了所有因术后诊断为胰腺恶性肿瘤而接受PD的患者。采用前向逐步多变量回归分析确定PD期间VR与患者人口统计学和合并症调整后的30天术后死亡率和发病率之间的相关性。纳入3，582例患者进行分析，其中281例（7.8%）在PD期间接受VR。PD期间的VR与风险调整后的30天术后死亡率[VR组5.7% vs无VR组2.9%，调整后比值比（AOR）2.1，95%置信区间（CI）1.22-3.73，P = 0.008]和总体发病率显著更高相关（VR组39.9% vs无VR组33.3%，AOR 1.36，95% CI 1.05-1.75，P = 0.02）。与先前发表的几项单中心分析结果相反，本研究表明，与PD单独治疗相比，PD合并VR的患者术后30天的发病率和死亡率增加。
Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source.A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjustment for patient demographics and comorbidities.3,582 patients were included for analysis, 281 (7.8 %) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality [5.7 % with VR versus 2.9 % without VR, adjusted odds ratio (AOR) 2.1, 95 % confidence interval (CI) 1.22-3.73, P = 0.008] and overall morbidity (39.9 % with VR versus 33.3 % without VR, AOR 1.36, 95 % CI 1.05-1.75, P = 0.02). There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team.Contrary to the findings of several previously published single-center analyses, the current study demonstrates increased 30-day postoperative morbidity and mortality in PD with VR when compared with PD alone.