Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel.
World J Surg Oncol. 2019 Jan 31;17(1):26. doi: 10.1186/s12957-019-1569-9.
Reoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early reoperation following PD and analyze its effect on short- and long-term outcome.
Four hundred and thirty-three patients that underwent PD between August 2006 and June 2016 were retrospectively analyzed.
Forty-eight patients (11%; ROp group) underwent 60 reoperations within 60 days from PD. Forty-two patients underwent 1 reoperation, and 6 had up to 6 reoperations. The average time to first reoperation was 10.1 ± 13.4 days. The most common indications were anastomotic leaks (22 operations in 18 patients; 37.5% of ROp), followed by post-pancreatectomy hemorrhage (PPH) (14 reoperations in 12 patients; 25%), and wound complications in 10 (20.8%). Patients with cholangiocarcinoma had the highest reoperation rate (25%) followed by ductal adenocarcinoma (12.3%). Reoperation was associated with increased length of hospital stay and a high post-operative mortality of 18.7%, compared to 2.6% for the non-reoperated group. For those who survived the post-operative period, the overall and disease-free survival were not affected by reoperation.
Early reoperations following PD carries a dramatically increased mortality rate, but has no impact on long-term survival.
PD 术后再次手术是术后过程复杂的替代指标，可能导致灾难性后果。我们评估 PD 后早期再次手术的适应证，并分析其对短期和长期结果的影响。
回顾性分析 2006 年 8 月至 2016 年 6 月期间接受 PD 的 433 例患者。
48 例患者（11%；ROP 组）在 PD 后 60 天内进行了 60 次再手术。42 例患者进行了 1 次再手术，6 例患者进行了多达 6 次再手术。首次再手术的平均时间为 10.1±13.4 天。最常见的手术指征为吻合口漏（18 例患者中的 22 例手术；ROP 占 37.5%），其次为胰腺切除术后出血（PPH；12 例患者中的 14 例手术；25%），10 例患者为伤口并发症（20.8%）。胆管癌患者的再手术率最高（25%），其次是导管腺癌（12.3%）。与未再手术组的 2.6%相比，再手术患者的住院时间延长，术后死亡率较高（18.7%）。对于术后存活的患者，再手术与否对总体生存率和无病生存率均无影响。
PD 术后早期再次手术死亡率显著增加，但对长期生存无影响。
