De Reuver Philip R, Mittal Anubhav, Neale Michael, Gill Anthony J, Samra Jaswinder S
Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
Surgery. 2015 Jul;158(1):183-90. doi: 10.1016/j.surg.2015.03.015. Epub 2015 Apr 25.
Recently, the International Study Group for Pancreatic Surgery presented a consensus statement on the definition of an extended pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Because extended resections are associated with increased morbidity and mortality, prognostic factors for outcome are mandatory to optimize patient selection. The aim of this study was to apply the new definition of an extended PD and to assess prognostic factors for short-term complications and survival in patients with PDAC.
A retrospective analysis was performed on a prospectively collected database running from 2004 to 2014. Inclusion criteria were all PD resections with histopathology-proven PDAC. Clinical data, operative results, and short- and long-term outcomes were analyzed.
We included 177 patients who underwent PD for PDAC in this study. Sixty-six patients (37%) underwent a standard PD and 111 (63%) underwent an extended PD. No differences were found in duration of postoperative stay (median, 13 days) or overall complication rate of 35% (n = 61). Severe complications occurred in 24 patients (13%). Male sex (odds ratio, 2.4; 95% CI, 0.9-6.6) was a prognostic factor for severe complications. There was no in-hospital or 90-day mortality in either group. Multivariate survival analysis showed that poor tumor differentiation (hazard ratio [HR], 2.0; 95% CI, 1.3-3.1), lymph node metastasis (HR, 2.3; 95% CI, 1.4-3.9), neural invasion (HR, 1.9; 95% CI, 1.2-3.1), were independent prognostic factors for worse survival. An extended resection was associated with worse survival, but was not an independent prognostic factor (HR, 1.5; 95% CI, 1.0-2.3).
Extended PD is associated with worse survival but not with increased morbidity.
最近，国际胰腺外科学研究小组发布了一份关于胰腺导管腺癌（PDAC）扩大胰十二指肠切除术（PD）定义的共识声明。由于扩大切除术会增加发病率和死亡率，因此必须明确影响手术结果的预后因素，以优化患者选择。本研究的目的是应用扩大PD的新定义，并评估PDAC患者短期并发症和生存的预后因素。
对2004年至2014年前瞻性收集的数据库进行回顾性分析。纳入标准为所有经组织病理学证实为PDAC的PD切除术。分析临床数据、手术结果以及短期和长期预后。
本研究纳入了177例行PD治疗PDAC的患者。66例患者（37%）接受了标准PD，111例（63%）接受了扩大PD。术后住院时间（中位数为13天）或总体并发症发生率35%（n = 61）无差异。24例患者（13%）发生严重并发症。男性（比值比，2.4；95%可信区间，0.9 - 6.6）是严重并发症的预后因素。两组均无院内死亡或90天死亡率。多因素生存分析显示，肿瘤分化差（风险比[HR]，2.0；95%可信区间，1.3 - 3.1）、淋巴结转移（HR，2.3；95%可信区间，1.4 - 3.9）、神经侵犯（HR，1.9；95%可信区间，1.2 - 3.1）是生存较差的独立预后因素。扩大切除术与较差的生存率相关，但不是独立的预后因素（HR，1.5；95%可信区间，1.0 - 2.3）。
扩大PD与较差的生存率相关，但与发病率增加无关。
