Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Department of Surgery, University Hospital of Verona, "Pancreas Institute," Verona, Italy.
Ann Surg. 2019 Aug;270(2):211-218. doi: 10.1097/SLA.0000000000003223.
To use the concept of benchmarking to establish robust and standardized outcome references after pancreatico-duodenectomy (PD).
Best achievable results after PD are unknown. Consequently, outcome comparisons among different cohorts, centers or with novel surgical techniques remain speculative.
This multicenter study analyzes consecutive patients (2012-2015) undergoing PD in 23 international expert centers in pancreas surgery. Outcomes in patients without significant comorbidities and major vascular resection (benchmark cases) were analyzed to establish 20 outcome benchmarks for PD. These benchmarks were tested in a cohort with a poorer preoperative physical status (ASA class ≥3) and a cohort treated by minimally invasive approaches.
Two thousand three hundred seventy-five (38%) low-risk cases out of a total of 6186 PDs were analyzed, disclosing low in-hospital mortality (≤1.6%) but high morbidity, with a 73% benchmark morbidity rate cumulated within 6 months following surgery. Benchmark cutoffs for pancreatic fistulas (B-C), severe complications (≥ grade 3), and failure-to-rescue rate were 19%, 30%, and 9%, respectively. The ASA ≥3 cohort showed comparable morbidity but a higher in hospital-mortality (3% vs 1.6%) and failure-to-rescue rate (16% vs 9%) than the benchmarks. The proportion of benchmark cases performed varied greatly across centers and continents for both open (9%-93%) and minimally invasive (11%-62%) PD. Centers operating mostly on complex PD cases disclosed better results than those with a majority of low-risk cases.
The proposed outcome benchmarks for PD, established in a large-scale international patient cohort and tested in 2 different cohorts, may allow for meaningful comparisons between different patient cohorts, centers, countries, and surgical techniques.
利用基准测试的概念，为胰十二指肠切除术（PD）后建立稳健且标准化的结果参考。
PD 后最佳可实现的结果尚不清楚。因此，不同队列、中心或与新手术技术之间的结果比较仍然是推测性的。
本多中心研究分析了 23 个国际胰腺外科专家中心 2012 年至 2015 年间连续接受 PD 的患者。对无明显合并症和主要血管切除的患者（基准病例）进行分析，以确定 20 个 PD 结果基准。这些基准在术前身体状况较差（ASA 分级≥3）的患者队列和接受微创方法治疗的患者队列中进行了测试。
在总共 6186 例 PD 中，分析了 2375 例（38%）低风险病例，结果显示院内死亡率较低（≤1.6%），但发病率较高，术后 6 个月内累积发病率为 73%。胰瘘（B-C）、严重并发症（≥3 级）和抢救失败率的基准切点分别为 19%、30%和 9%。ASA≥3 组的发病率相似，但院内死亡率（3%比 1.6%）和抢救失败率（16%比 9%）更高。对于开放 PD（9%-93%）和微创 PD（11%-62%），不同中心和大洲的基准病例比例差异很大。主要处理复杂 PD 病例的中心比主要处理低风险病例的中心报告的结果更好。
本研究在大规模国际患者队列中建立了 PD 结果基准，并在 2 个不同队列中进行了测试，这些基准可能允许在不同患者队列、中心、国家和手术技术之间进行有意义的比较。
