预防性胆囊切除术在小肠神经内分泌肿瘤手术时并不会增加术后并发症。

Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.

Ann Surg Oncol. 2018 Jan;25(1):239-245. doi: 10.1245/s10434-017-6093-y. Epub 2017 Oct 24.

BACKGROUND

Prophylactic cholecystectomy at time of surgery for small bowel neuroendocrine tumor (SBNET) has been advocated, as these patients often go on to require somatostatin analogue therapy, which is known to increase risk of cholestasis and associated complications. Little is known regarding patterns of adoption of this practice or its associated morbidity.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database (2008-2014) was queried to identify patients who underwent SBNET resection. The risk differences of morbidity and mortality associated with performance of concurrent cholecystectomy were determined with multivariable adjustment for confounders.

RESULTS

Among 1300 patients who underwent SBNET resection, 144 (11.1%) underwent concurrent cholecystectomy. Median age of patients undergoing cholecystectomy was 62 years [interquartile range (IQR) 52-69 years], and 75 were male. They more commonly had disseminated cancer (36.1 vs. 11.6%, p < 0.001) or SBNET located in duodenum (10.4 vs. 4.9%, p = 0.045) without difference in other baseline characteristics. Operative time was significantly longer in the cholecystectomy group (median 172 vs. 123 min, p < 0.001). Rate of postoperative morbidity was not significantly different between cholecystectomy and no-cholecystectomy groups (11.8 vs. 11.1%, p = 0.79). After adjustment for confounding, the risk difference of morbidity attributable to cholecystectomy was + 0.4% [95% confidence interval (CI) - 4.9 to + 5.6%]. Mortality within 30 days was not significantly different between cholecystectomy and no-cholecystectomy groups (1.4 vs. 0.6%, p = 0.29).

CONCLUSIONS

Concurrent cholecystectomy at time of resection of SBNET is not associated with higher morbidity or mortality yet is performed in a minority of patients. Prospective study can identify which patients may derive benefit from this approach.

背景

在进行小肠神经内分泌肿瘤（SBNET）手术时，预防性胆囊切除术已被提倡，因为这些患者通常需要接受生长抑素类似物治疗，而这种治疗已知会增加胆汁淤积和相关并发症的风险。对于这种做法的采用模式或其相关发病率知之甚少。

方法

查询美国外科医师学院国家手术质量改进计划数据库（2008-2014 年），以确定接受 SBNET 切除术的患者。通过多变量调整混杂因素，确定同时行胆囊切除术与发病率和死亡率相关的风险差异。

结果

在 1300 例接受 SBNET 切除术的患者中，有 144 例（11.1%）同时行胆囊切除术。行胆囊切除术的患者中位年龄为 62 岁[四分位间距（IQR）52-69 岁]，75 例为男性。他们更常见弥漫性癌症（36.1%比 11.6%，p<0.001）或 SBNET 位于十二指肠（10.4%比 4.9%，p=0.045），其他基线特征无差异。胆囊切除术组的手术时间明显更长（中位数 172 分钟比 123 分钟，p<0.001）。胆囊切除术组和非胆囊切除术组的术后发病率无显著差异（11.8%比 11.1%，p=0.79）。在调整混杂因素后，归因于胆囊切除术的发病率风险差异为+0.4%[95%置信区间（CI）-4.9%至+5.6%]。30 天内死亡率在胆囊切除术组和非胆囊切除术组之间无显著差异（1.4%比 0.6%，p=0.29）。