Mukherjee S, Kocher H M, Hutchins R R, Bhattacharya S, Abraham A T
Barts and the London HPB Centre, The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom.
Eur J Surg Oncol. 2009 Jul;35(7):734-8. doi: 10.1016/j.ejso.2008.04.006. Epub 2008 Jun 10.
High hospital volume has a favorable impact on outcomes for complex procedures including pancreaticoduodenectomy (PD); however, the temporal relationship has not been evaluated in a single centre.
To evaluate the impact of UK cancer outcome guidelines (COG) on outcomes for PD in a single UK HPB specialist centre.
All patients with pancreatic pathologies undergoing surgery at our institution from 1999 to 2006 were identified, of which 140 underwent PD. The annual caseload for PD and corresponding outcomes for length of hospital stay, morbidity, mortality and survival were analysed during the period around the implementation of UK COG with an increase in the surgical workload correlating with catchment's population increase from 1.6 to 3.1 million.
Between January 1999 and December 2006, 140 patients underwent a PD (M:F 1.06:1; median age 64 (range 34-84) years). Median hospital stay was 16 days (range 7-318). The 30-day mortality was 2.8%, in-hospital mortality was 6.4% and morbidity was 37.1%. Pancreatic leak/fistula rate was 8.6%. Over the 7-year period, PDs per year increased 5.3 fold from 6 procedures in 1999 to 32 in 2006. Analysis of the data for 1999-2002-(pre-COG) and 2003-2006-(post-COG) showed a trend towards decrease in mortality (from 9.7% to 5.0%, p = 0.448: OR = 2.74 (95% CI, 0.58-12.88); Fisher's exact test) and morbidity (from 41.6% to 35.3%; OR = 1.29 (95% CI, 0.74-3.56); p = 0.565).
With COG implementation within a single UK pancreatic unit, the PD volume and staffing levels increased with a trend towards decreased morbidity and mortality.
高医院手术量对包括胰十二指肠切除术（PD）在内的复杂手术的预后有积极影响；然而，这种时间关系尚未在单一中心进行评估。
评估英国癌症预后指南（COG）对英国一家单一的肝脏胰腺胆管（HPB）专科中心PD手术预后的影响。
确定了1999年至2006年期间在我们机构接受胰腺疾病手术的所有患者，其中140例接受了PD手术。在英国COG实施前后期间，分析了PD的年度病例数以及相应的住院时间、发病率、死亡率和生存率等预后指标，在此期间手术工作量的增加与服务人口从160万增加到310万相关。
1999年1月至2006年12月期间，140例患者接受了PD手术（男：女为1.06：1；中位年龄64岁（范围34 - 84岁））。中位住院时间为16天（范围7 - 318天）。30天死亡率为2.8%，住院死亡率为6.4%，发病率为37.1%。胰瘘发生率为8.6%。在这7年期间，每年的PD手术例数从最初1999年的6例增加到2006年的32例，增长了5.3倍。对1999 - 2002年（COG实施前）和2003 - 2006年（COG实施后）的数据进行分析，结果显示死亡率有下降趋势（从9.7%降至5.0%，p = 0.448；OR = 2.74（95%CI，0.58 - 12.88）；Fisher精确检验），发病率也有下降趋势（从41.6%降至35.3%；OR = 1.29（95%CI，0.74 - 3.56）；p = 0.565）。
在英国一家单一的胰腺科室实施COG后，PD手术量和人员配备水平有所增加，同时发病率和死亡率有下降趋势。
