Narayanan Sowmya, Martin Allison N, Turrentine Florence E, Bauer Todd W, Adams Reid B, Zaydfudim Victor M
Department of Surgery, University of Virginia, Charlottesville, Virginia.
Department of Surgery, University of Virginia, Charlottesville, Virginia; Surgery Outcomes Research Center, University of Virginia, Charlottesville, Virginia.
J Surg Res. 2018 Nov;231:304-308. doi: 10.1016/j.jss.2018.05.075. Epub 2018 Jun 27.
Safety of pancreaticoduodenectomy has improved significantly in the past 3 decades. Current inpatient and 30-d mortality rates are low. However, incidence and causes of 90-d and 1-y mortality are poorly defined and largely unexplored.
All patients who had pancreaticoduodenectomy between 2007 and 2016 were included in this single institution, retrospective cohort study. Distributions of pancreaticoduodenectomy-specific morbidity and cause-specific mortality were compared between early (within 90 d) and late (91-365 d) postoperative recovery periods.
A total of 551 pancreaticoduodenectomies were performed during the study period. Of these, 6 (1.1%), 20 (3.6%), and 91 (16.5%) patients died within 30, 90, and 365 d after pancreaticoduodenectomy, respectively. Causes of early and late mortality varied significantly (all P ≤ 0.032). The most common cause of death within 90 d was due to multisystem organ failure from sepsis or aspiration in 9 (45%) patients, followed by post-pancreatectomy hemorrhage in 5 (25%) patients, and cardiopulmonary arrest from myocardial infarction or pulmonary embolus in 3 (15%) patients. In contrast, recurrent cancer was the most common cause of death in 46 (65%) patients during the late postoperative period between 91 and 365 d. Mortality from failure to thrive and debility was similar between early and late postoperative periods (15% versus 19.7%, P = 0.76).
Most quality improvement initiatives in patients selected for pancreaticoduodenectomy have focused on reduction of technical complications and improvement of early postoperative mortality. Further reduction in postoperative mortality after pancreaticoduodenectomy can be achieved by improving patient selection, mitigating postoperative malnutrition, and optimizing preoperative cancer staging and management strategies.
在过去30年里，胰十二指肠切除术的安全性有了显著提高。目前住院患者及30天死亡率较低。然而，90天和1年死亡率的发生率及原因尚不明确，且在很大程度上未被探究。
本单中心回顾性队列研究纳入了2007年至2016年间所有接受胰十二指肠切除术的患者。比较了术后早期（90天内）和晚期（91 - 365天）胰十二指肠切除术特异性发病率及死因特异性死亡率的分布情况。
研究期间共进行了551例胰十二指肠切除术。其中，分别有6例（1.1%）、20例（3.6%）和91例（16.5%）患者在胰十二指肠切除术后30天、90天和365天内死亡。早期和晚期死亡原因差异显著（所有P≤0.032）。90天内最常见的死亡原因是9例（45%）患者因败血症或误吸导致多系统器官衰竭，其次是5例（25%）患者发生胰十二指肠切除术后出血，以及3例（15%）患者因心肌梗死或肺栓塞导致心肺骤停。相比之下，复发癌是91至365天术后晚期46例（65%）患者最常见的死亡原因。术后早期和晚期因衰弱和虚弱导致的死亡率相似（15%对19.7%，P = 0.76）。
大多数选择接受胰十二指肠切除术患者的质量改进措施都集中在减少技术并发症和降低术后早期死亡率上。通过改善患者选择、减轻术后营养不良以及优化术前癌症分期和管理策略，可进一步降低胰十二指肠切除术后的死亡率。
