Rangelova Elena, Blomberg John, Ansorge Christoph, Lundell Lars, Segersvärd Ralf, Del Chiaro Marco
Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
J Gastrointest Surg. 2015 Mar;19(3):492-7. doi: 10.1007/s11605-014-2738-3. Epub 2015 Jan 7.
Pancreas-preserving duodenectomy (PPD) can be considered a technical alternative to pancreaticoduodenectomy for the treatment of premalignant/low-grade malignant lesions of the duodenum. However, no many data are available comparing surgical results and costs of these two procedures.
Prospectively collected data from the Karolinska University Hospital's electronic database was analyzed retrospectively for patients who underwent PD and PPD between January 2006 and December 2011. The demographics, length of stay (LOS), postoperative morbidity and mortality, and hospital costs were analyzed.
Twenty patients operated with PPD and 369 with PD were identified. Of the PDs, 81 were classified as HR-PDs, based on the intraoperative assessment of the gland. PPD patients were younger than those with HR-PD (50 vs 62 years; p = 0.0003), and with slight prevalence of overweight, BMI ≥25 (60 vs 45.7 %; p = 0.2). No differences were found in overall morbidity (55 vs 68 %; p = 0.3), in severe postoperative complications-Dindo-Clavien grade ≥3b (20 vs 30 %; p = 0.3), in delayed gastric emptying (10 vs 12 %, ns), and postpancreatectomy hemorrhage (10 vs 7.4 %, ns) between PPD and HR-PDs. However, the incidence of POPF was marginally lower in the PPD group (15 vs 37 %; p = 0.06) and was treated conservatively, while ten patients in the HR-PD group were reoperated and with POPF-associated mortality of 40 %. Also, shorter ICU stay (5 vs 12.%, ns), lower reoperation rate (10 vs 21 %, ns), lower mortality (0 vs 6.2 %), and shorter LOS (16.9 vs 24.6 days) were observed with PPD compared to HR-PD, but the numbers did not reach statistical significance. PPD was performed with shorter operative time (319 vs 418 min; p < 0.0001) and less intra-operative blood loss than HR-PD (521 vs 1027 ml; p = 0.003). The hospital costs for PPD were significantly lower than for HR-PD (29,170 vs 53,080 Euro, p = 0.03) CONCLUSIONS: PPD for resection of premalignant and low-grade malignant duodenal lesions in this small series shows to be an equivalent alternative to HR-PD, as it can be performed with shorter operative time, less intraoperative blood loss, and comparable, even slightly better, postoperative outcome and with lower costs.
保留胰腺的十二指肠切除术（PPD）可被视为胰十二指肠切除术治疗十二指肠癌前/低级别恶性病变的一种技术替代方案。然而，关于这两种手术的手术结果和成本比较，可用数据不多。
回顾性分析2006年1月至2011年12月期间在卡罗林斯卡大学医院接受胰十二指肠切除术（PD）和保留胰腺的十二指肠切除术（PPD）患者的前瞻性收集的电子数据库数据。分析了人口统计学、住院时间（LOS）、术后发病率和死亡率以及医院成本。
确定了20例行PPD手术的患者和369例行PD手术的患者。在PD患者中，根据术中对胰腺的评估，81例被归类为高危PD（HR-PD）。PPD患者比HR-PD患者年轻（50岁对62岁；p = 0.0003），超重（BMI≥25）患病率略高（60%对45.7%；p = 0.2）。PPD组与HR-PD组在总体发病率（55%对68%；p = 0.3）、严重术后并发症（Dindo-Clavien分级≥3b）（20%对30%；p = 0.3）、胃排空延迟（10%对12%，无统计学意义）和胰十二指肠切除术后出血（10%对7.4%；无统计学意义）方面无差异。然而，PPD组胰瘘（POPF）发生率略低（15%对37%；p = 0.06），且采用保守治疗，而HR-PD组有10例患者再次手术，POPF相关死亡率为40%。此外，与HR-PD相比，PPD组的重症监护病房（ICU）住院时间更短（5%对12%，无统计学意义）、再次手术率更低（10%对21%，无统计学意义）死亡率更低（0对6.2%）、住院时间更短（16.9天对24.6天），但这些数字未达到统计学意义。PPD手术时间比HR-PD短（319分钟对418分钟；p < 0.0001），术中失血量也比HR-PD少（521毫升对1027毫升；p = 0.003）。PPD的医院成本显著低于HR-PD（29,170欧元对53,080欧元，p = 0.03）。结论：在这个小系列中，PPD用于切除十二指肠癌前和低级别恶性病变显示出是HR-PD的等效替代方案，因为它可以在更短的手术时间内进行，术中失血量更少，术后结果相当甚至略好，且成本更低。
