Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
World J Surg. 2013 Sep;37(9):2229-33. doi: 10.1007/s00268-013-2108-4.
The perioperative period is critical in the outcome for patients with pancreatic cancer. The aim of the present analysis was to examine adverse events in patients dying under surgical care in relation to changes in the organization of pancreatic cancer surgery.
From 1996 to 2005, 1,033 patients with pancreatic cancer, mean age of 71 years (range 21-97 years) died under surgical care. The incidence, mortality, and number of operations for pancreatic cancer remained stable across the time period, but the proportion of patients undergoing surgery in the five specialist cancer centers increased from 50 to 80 % (p < 0.001). Prior to death 260 (25 %) patients underwent operation and 96 (9 %) had endoscopic retrograde cholangiopancreatography (ERCP). There was a significant rise in ERCP (p = 0.03) and a decrease in non-resectional operations (p = 0.001).
Since 1996, 52 (15 %) patients in whom 90 adverse events were recorded died following surgical intervention: 28 adverse events related to the perioperative period with 15 due to direct procedure complications such as bleeding or anastomotic leak; 13 were attributed to decision making around the choice or timing of the procedure. The postoperative mortality after curative pancreatic resection reduced from 3.5 to 1.8 %. Identified adverse events fell significantly in patients who died relating to the operative period (median of 3 per annum [1994-2000] to 1 per annum [2001-2005]) (p = 0.014) and medical care (3-0) (p = 0.003).
Continuous peer review audit has demonstrated a reduction in the number of adverse events in patients dying with pancreatic cancer under surgical care as increased numbers of patients treated in specialist cancer centers.
围手术期是胰腺癌患者预后的关键时期。本分析的目的是研究在外科治疗下死亡的胰腺癌患者的不良事件与胰腺癌手术组织变化之间的关系。
1996 年至 2005 年，1033 例胰腺癌患者在外科治疗下死亡，平均年龄 71 岁（范围 21-97 岁）。在整个研究期间，胰腺癌的发病率、死亡率和手术例数保持稳定，但在 5 家专业癌症中心接受手术治疗的患者比例从 50%增加到 80%（p<0.001）。在死亡前，260 例（25%）患者接受了手术，96 例（9%）进行了内镜逆行胰胆管造影（ERCP）。ERCP 的比例显著上升（p=0.03），非切除术的比例下降（p=0.001）。
自 1996 年以来，52 例（15%）接受手术干预的患者在手术后死亡，记录了 90 例不良事件：28 例与围手术期相关的不良事件，其中 15 例是由于直接手术并发症，如出血或吻合口漏；13 例归因于手术选择或时机的决策。根治性胰腺切除术后的术后死亡率从 3.5%降至 1.8%。在与手术期间（中位数每年 3 例[1994-2000]至每年 1 例[2001-2005]）（p=0.014）和医疗保健（3-0）（p=0.003）相关的死亡患者中，不良事件的数量显著减少。
随着越来越多的患者在专业癌症中心接受治疗，连续的同行评审审计表明，在外科治疗下死亡的胰腺癌患者的不良事件数量有所减少。
