Casadei Riccardo, Ricci Claudio, Taffurelli Giovanni, Guariniello Anna, Di Gioia Anthony, Di Marco Mariacristina, Pagano Nico, Serra Carla, Calculli Lucia, Santini Donatella, Minni Francesco
Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
Department of Specialist, Diagnostic and Experimental Medicine (DIMES), S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
J Gastrointest Surg. 2016 Sep;20(9):1595-607. doi: 10.1007/s11605-016-3201-4. Epub 2016 Jul 14.
Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy.
A single center, prospective, observational trial, regarding postoperative outcomes, long-term results, and cost-effectiveness, in a tertiary referral center was conducted, comparing consecutive patients who underwent elective total pancreatectomy and/or pancreaticoduodenectomy.
Seventy-three consecutive elective total pancreatectomies and 184 pancreaticoduodenectomies were compared. There were no significant differences regarding postoperative outcomes and overall survival. The quality of life, evaluated in 119 patients according to the EQ-5D-5L questionnaire, showed that there were no significant differences regarding the five items considered. The mean EQ-5D-5L score was similar in the two procedures (total pancreatectomy = 0.872, range 0.345-1.000; pancreaticoduodenectomy = 0.832, range 0.393-1.000; P = 0.320). The impact of diabetes according to the Problem Areas in Diabetes (PAID) questionnaire did not show any significant differences except for question 13 (total pancreatectomy = 0.60; pancreaticoduodenectomy = 0.19; P = 0.022). The cost-effectiveness analysis suggested that the quality-adjusted life year was not significantly different between the two procedures (total pancreatectomy = 0.910, range 0.345-1.000; pancreaticoduodenectomy = 0.910, range -0.393-1.000; P = 0.320).
From this study, it seems reasonable to suggest that total pancreatectomy can be considered as safe, feasible, and efficacious as PD and acceptable in terms of cost-effectiveness.
尽管目前尚无部分胰腺切除术与全胰腺切除术之间的大型对比研究，但在特定患者中，全胰腺切除术实际上被视为一种可行的选择。我们的目的是评估全胰腺切除术是否可被认为与胰十二指肠切除术一样可行、安全、有效且具有成本效益。
在一家三级转诊中心进行了一项单中心、前瞻性观察性试验，涉及术后结果、长期疗效和成本效益，比较了连续接受择期全胰腺切除术和/或胰十二指肠切除术的患者。
比较了73例连续的择期全胰腺切除术和184例胰十二指肠切除术。术后结果和总生存率无显著差异。根据EQ-5D-5L问卷对119例患者进行的生活质量评估显示，所考虑的五个项目无显著差异。两种手术的平均EQ-5D-5L评分相似（全胰腺切除术=0.872，范围0.345-1.000；胰十二指肠切除术=0.832，范围0.393-1.000；P=0.320）。根据糖尿病问题领域（PAID）问卷评估的糖尿病影响，除问题13外无显著差异（全胰腺切除术=0.60；胰十二指肠切除术=0.19；P=0.022）。成本效益分析表明，两种手术的质量调整生命年无显著差异（全胰腺切除术=0.910，范围0.345-1.000；胰十二指肠切除术=0.910，范围-0.393-1.000；P=0.320）。
从这项研究来看，似乎有理由认为全胰腺切除术与胰十二指肠切除术一样安全、可行且有效，并且在成本效益方面是可接受的。
