Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH541, Indianapolis, IN, 46202, USA.
Surg Endosc. 2018 Jan;32(1):428-435. doi: 10.1007/s00464-017-5700-0. Epub 2017 Jun 29.
Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis.
All patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a high-volume center from November 2006 to 2015 were prospectively collected using ACS-NSQIP at our institution. Patients with additional multivisceral or enucleation procedures were excluded. Data were augmented to 90-day outcomes using our institutional database.
Forty-three patients with a mean age of 62 years (27:16 male: female) underwent P+C, accounting for 2.39% (43/1797) of pancreatectomies performed. Pancreatoduodenectomy (PD) was performed in 61% (n = 26), distal pancreatectomy (DP) in 37% (n = 16), and total pancreatectomy (TP) in 2% (n = 1) of patients. The 30- and 90-day MM were higher in P+C than P (30-day: 54 vs. 37%, p = 0.037 and 9 vs. 2%, p = 0.022; 90-day: 61 vs. 42%, p = 0.019 and 14 vs. 3%, p = 0.002). Logistical regression modeling revealed an association between 90-day mortality and colectomy (p = 0.013, OR = 3.556). When P+C MM were analyzed according to intraoperative factors, there was no significant difference according to type of pancreatectomy (PD vs. DP vs. TP), origin of primary lesion (pancreas vs. colon), surgical indication (malignant vs. non-malignant), or case status (planned colectomy vs. intraoperative decision).
Addition of colectomy to pancreatectomy substantially increased MM. Subanalysis revealed that type of resection performed, etiology, and planning status did not account for increased risk when performing P+C. However, colectomy was found to be an independent risk factor for mortality. Therefore, patients should be informed of the risk of increased postoperative complications until a further study can identify potential patients or perioperative factors that can be used for risk stratification.
为了切除胰腺或结肠病变，通常需要进行相邻器官的积极整块切除术。然而，同时进行胰结肠切除术（P+C）是否合理仍存在争议，因为这可能会增加发病率和死亡率（MM）。我们假设 P+C 会增加 MM，特别是在胰腺炎的情况下。
使用我们机构的 ACS-NSQIP 前瞻性收集了 2006 年 11 月至 2015 年在高容量中心接受胰切除术（P）和同时胰结肠切除术（P+C）的所有患者。排除了其他多内脏或剜除手术的患者。使用我们机构的数据库将数据扩充至 90 天的结果。
43 名平均年龄为 62 岁（27：16 男：女）的患者接受了 P+C，占同期 1797 例胰切除术的 2.39%（43/1797）。胰十二指肠切除术（PD）占 61%（n=26），胰体尾切除术（DP）占 37%（n=16），全胰切除术（TP）占 2%（n=1）。P+C 的 30 天和 90 天 MM 高于 P（30 天：54%比 37%，p=0.037 和 9%比 2%，p=0.022；90 天：61%比 42%，p=0.019 和 14%比 3%，p=0.002）。逻辑回归模型显示，90 天死亡率与结肠切除术相关（p=0.013，OR=3.556）。当根据术中因素分析 P+C 的 MM 时，根据胰腺切除术的类型（PD 与 DP 与 TP）、原发灶的来源（胰腺与结肠）、手术指征（恶性与非恶性）或病例状态（计划结肠切除术与术中决定），差异均无统计学意义。
胰切除术加结肠切除术显著增加了 MM。亚分析显示，当进行 P+C 时，所进行的切除术类型、病因和计划状态并不能解释风险增加。然而，结肠切除术是死亡的独立危险因素。因此，应告知患者术后并发症增加的风险，直到进一步的研究能够确定可用于风险分层的潜在患者或围手术期因素。
