Jorgensen Matthew S, Almerey Tariq, Farres Houssam, Oldenburg W Andrew, Stauffer John, Hakaim Albert G
Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
J Gastrointest Oncol. 2019 Feb;10(1):95-102. doi: 10.21037/jgo.2018.10.03.
Major vascular reconstruction during a pancreaticoduodenectomy (PD), also known as a Whipple procedure, leads to controversial postoperative outcomes compared to conventional Whipple. Discussion with the patient regarding postoperative expectations is a crucial component of holistic surgical healthcare. The aim of this study was to report our 8-year experience of Whipple procedures involving vascular reconstruction and to review relevant literature to further evaluate expectant outcomes, therefore leading to more accurate discussion.
A retrospective review of patients undergoing Whipple procedures from January 2010, through December 2017 was performed. Patch, graft, and primary anastomosis during Whipple procedures were considered major vascular reconstruction. Literature on the current understanding of the outcomes associated with vascular reconstruction during Whipple procedures was reviewed.
Twenty-nine from a total of 405 patients that met inclusion criteria had a Whipple procedure that involved major vascular reconstruction. Twelve patients were male and 17 were female (mean age, 65.2 years). Median hospital and intensive care unit (ICU) stay [range] of patients with vascular reconstruction was 12 [5-92] days and 3 [0-59] days, respectively. Thirty-day survival and 1-year survival of patients with vascular reconstruction was 93.1% and 55.2%, respectively, compared to non-vascular reconstruction patients 96.0% and 83.5%, respectively (P=0.35, P<0.001). Ninety-day readmission for vascular reconstruction patients was 31.0% compared to 14.6% in non-vascular reconstruction patients (P=0.03). The 1-year survival of those who had patch reconstruction, graft reconstruction, and primary anastomosis was 50.0%, 62.5%, 53.8%, respectively.
Compared to conventional Whipple procedures, those requiring major vascular reconstruction are associated with decreased survival. When vascular reconstruction is a valid option patients should be well aware of the associated outcomes.
胰十二指肠切除术（PD，也称为惠普尔手术）中的主要血管重建与传统惠普尔手术相比，术后结果存在争议。与患者讨论术后预期是整体外科医疗保健的关键组成部分。本研究的目的是报告我们8年中涉及血管重建的惠普尔手术经验，并回顾相关文献以进一步评估预期结果，从而进行更准确的讨论。
对2010年1月至2017年12月期间接受惠普尔手术的患者进行回顾性研究。惠普尔手术中的补片、移植物和原位吻合被视为主要血管重建。回顾了关于目前对惠普尔手术中血管重建相关结果理解的文献。
405例符合纳入标准的患者中，29例接受了涉及主要血管重建的惠普尔手术。12例为男性，17例为女性（平均年龄65.2岁）。血管重建患者的中位住院时间和重症监护病房（ICU）住院时间[范围]分别为12[5 - 92]天和3[0 - 59]天。血管重建患者的30天生存率和1年生存率分别为93.1%和55.2%，而非血管重建患者分别为96.0%和83.5%（P = 0.35，P < 0.001）。血管重建患者的90天再入院率为31.0%，而非血管重建患者为14.6%（P = 0.03）。接受补片重建、移植物重建和原位吻合患者的1年生存率分别为50.0%、62.5%、53.8%。
与传统惠普尔手术相比，需要进行主要血管重建的手术生存率较低。当血管重建是一个可行选择时，患者应充分了解相关结果。
