Beenen E, van Roest M H G, Sieders E, Peeters P M J G, Porte R J, de Boer M T, de Jong K P
Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Eur J Surg Oncol. 2014 Aug;40(8):989-94. doi: 10.1016/j.ejso.2013.12.019. Epub 2014 Feb 8.
To compare the burden of total hospitalization as a ratio of survival of staging laparoscopy versus prophylactic bypass surgery in patients with unresectable periampullary adenocarcinoma.
Periampullary adenocarcinoma is an aggressive cancer with up to 35% of the patients at surgery found to be unresectable. Palliative prophylactic surgical bypass versus endoscopic stenting has been addressed by randomized controlled trials, but none reported on the burden of hospitalization.
From a prospective database all patients with periampullary adenocarcinomas with a preoperative patent biliary stent and absent gastric outlet obstruction, but found unresectable during surgery, were analysed. They underwent a staging laparoscopy only versus prophylactic palliative bypass surgery. In-hospital days of the initial admission as well as all consecutive admission days during the remaining life span were compared both in absolute numbers and as relative impact.
The inclusion criteria were met by 205 patients. Of these 131 patients underwent a staging laparoscopy detecting metastases in 21 patients. In 184 laparotomies 54 patients underwent prophylactic palliative bypass surgery for unresectable disease. Median total in-hospital-stay in the Laparoscopy Group was 3 days versus 11 days in the Palliative Bypass Group (p = 0.0003). Patients with metastatic disease found during laparoscopy stayed 3.5% of the remaining life time in hospital vs. 10.0% (p = 0.029) in patients with metastatic disease who underwent bypass surgery.
Staging laparoscopy and early discharge in patients with metastatic peri-ampullary carcinoma resulted in reduced hospitalization, both in absolute number of days and as a rate of survival time.
比较不可切除的壶腹周围腺癌患者分期腹腔镜检查与预防性旁路手术的总住院负担（以生存率为比率）。
壶腹周围腺癌是一种侵袭性癌症，高达35%的手术患者被发现不可切除。随机对照试验已探讨了姑息性预防性手术旁路与内镜支架置入术，但均未报告住院负担情况。
从一个前瞻性数据库中分析所有壶腹周围腺癌患者，这些患者术前有通畅的胆道支架且无胃出口梗阻，但手术中发现不可切除。他们仅接受分期腹腔镜检查或预防性姑息性旁路手术。比较初次入院的住院天数以及剩余寿命期间所有连续入院天数的绝对数量和相对影响。
205例患者符合纳入标准。其中131例患者接受了分期腹腔镜检查，21例发现有转移。在184例开腹手术中，54例患者因不可切除疾病接受了预防性姑息性旁路手术。腹腔镜检查组的中位总住院天数为3天，而姑息性旁路手术组为11天（p = 0.0003）。腹腔镜检查时发现有转移疾病的患者住院天数占剩余寿命的3.5%，而接受旁路手术的有转移疾病患者为10.0%（p = 0.029）。
对于转移性壶腹周围癌患者，分期腹腔镜检查及早期出院可减少住院天数及住院天数占生存时间的比率。
