Toomey Paul, Childs Christopher, Luberice Kenneth, Ross Sharona, Rosemurgy Alexander
The Southeastern Center for Digestive Disorders & Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, Florida 33613, USA.
Am Surg. 2013 Aug;79(8):781-5.
Nontherapeutic celiotomy for pancreatic adenocarcinoma is detrimental to patients by delaying medical treatment as a result of unnecessarily incurred postoperative recovery time. This study was undertaken to evaluate whether surgeon volume of pancreaticoduodenectomy for pancreatic adenocarcinoma impacted the incidence of nontherapeutic celiotomy. All patients undergoing an intended pancreaticoduodenectomy for pancreatic adenocarcinoma were evaluated from 2003 to 2012. Survival was calculated using Kaplan-Meier analysis. The association between surgeon volume of pancreaticoduodenectomy and occurrence of nontherapeutic celiotomy was assessed using Fisher's exact test. Median data are presented. Eight surgeons undertook 443 intended pancreaticoduodenectomies for patients with pancreatic adenocarcinoma; 329 (74%) patients underwent pancreaticoduodenectomy, whereas 114 (26%) patients underwent nontherapeutic celiotomies. Two surgeons undertook 85 per cent of operations. Surgeon volume did not impact the incidence of nontherapeutic celiotomies (P = 0.26). Seventy-seven (68%) patients had metastatic disease at the time of the operation, whereas 37 (32%) patients had locally advanced unresectable disease. These patients had survivals of 5.0 and 6.0 months, respectively (P = 0.77). A high proportion of patients--one in four--undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma will ultimately undergo a nontherapeutic celiotomy. Surgeon volume of pancreaticoduodenectomy for pancreatic adenocarcinoma does not lessen the incidence of nontherapeutic celiotomies. Preoperative prediction of patients with imaging-occult metastatic or locally advanced disease remains a challenge, even for high-volume surgeons. Attempts to create algorithms for patients with high risk of imaging-occult metastatic or locally advanced disease to undergo staging laparoscopy and/or positron emission tomography scanning may decrease the burden of patients undergoing nontherapeutic celiotomies.
因不必要的术后恢复时间而延误治疗，对胰腺癌患者进行非治疗性剖腹探查术是有害的。本研究旨在评估胰腺癌胰十二指肠切除术的术者手术量是否会影响非治疗性剖腹探查术的发生率。对2003年至2012年期间所有计划进行胰腺癌胰十二指肠切除术的患者进行评估。采用Kaplan-Meier分析计算生存率。使用Fisher精确检验评估胰腺癌胰十二指肠切除术的术者手术量与非治疗性剖腹探查术发生之间的关联。呈现中位数数据。八位术者为胰腺癌患者进行了443例计划中的胰十二指肠切除术；329例（74%）患者接受了胰十二指肠切除术，而114例（26%）患者接受了非治疗性剖腹探查术。两位术者完成了85%的手术。术者手术量并未影响非治疗性剖腹探查术的发生率（P = 0.26）。77例（68%）患者在手术时已有转移性疾病，而37例（32%）患者患有局部晚期不可切除疾病。这些患者的生存期分别为5.0个月和6.0个月（P = 0.77）。相当高比例的胰腺癌胰十二指肠切除术患者——四分之一——最终将接受非治疗性剖腹探查术。胰腺癌胰十二指肠切除术的术者手术量并不能降低非治疗性剖腹探查术的发生率。即使对于手术量高的术者，术前对影像隐匿性转移或局部晚期疾病患者的预测仍然是一项挑战。尝试为影像隐匿性转移或局部晚期疾病高风险患者创建算法以进行分期腹腔镜检查和/或正电子发射断层扫描，可能会减轻接受非治疗性剖腹探查术患者的负担。
