Department of Digestive Surgery, University Hospital of Caen, France; NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France.
Department of Digestive Surgery, University Hospital of Strasbourg, France.
Eur J Surg Oncol. 2018 Jul;44(7):1078-1082. doi: 10.1016/j.ejso.2018.03.024. Epub 2018 Apr 10.
Postoperative complications influence overall and disease free survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma is still a matter of debate and controversy.
The outcome of 942 consecutive patients, from the multicentric study of the French Association of Surgery, between January 2004 and December 2009 was analyzed. Perioperative data, including severe complications (grade III and above), were used in univariate and multivariate analysis to assess their influence on overall and disease free survival. Recurrence and its location were investigated as well.
Median overall and disease free survival were 24 and 19 months respectively. Postoperative complications occurred in 444 patients (47%) with 18.3% of severe complications. On multivariate analysis, severe complications, positive lymph node status and R1-R2 resection were independent prognostic factors for both overall and disease free survival. The median overall survival decreased from 25 to 22 months (p = 0.005) and disease free survival from 21 to 16 months (p = 0.02) if severe complications occurred. Severe complications were independent prognostic factor of recurrence (p < 0.001).
Severe complications significantly alter both overall and disease free survival and are an independent factor of recurrence.
胰十二指肠切除术治疗胰腺导管腺癌术后并发症对总生存和无病生存的影响仍存在争议。
本研究对 2004 年 1 月至 2009 年 12 月期间，法国外科协会多中心研究的 942 例连续患者的结局进行了分析。使用围手术期数据（包括严重并发症[III 级及以上]）进行单因素和多因素分析，以评估其对总生存和无病生存的影响。还研究了复发及其位置。
中位总生存和无病生存分别为 24 个月和 19 个月。444 例（47%）患者发生术后并发症，其中 18.3%为严重并发症。多因素分析显示，严重并发症、阳性淋巴结状态和 R1-R2 切除是总生存和无病生存的独立预后因素。严重并发症发生时，中位总生存从 25 个月降至 22 个月（p=0.005），无病生存从 21 个月降至 16 个月（p=0.02）。严重并发症是复发的独立预后因素（p<0.001）。
严重并发症显著改变总生存和无病生存，是复发的独立因素。
