School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Gastrointest Surg. 2020 Jul;24(7):1581-1589. doi: 10.1007/s11605-020-04641-3. Epub 2020 May 14.
Long-term complications following pancreatoduodenectomy (PD) can significantly impact quality of life and healthcare utilization. Most reports focus on short-term (within 90 days) PD outcomes; however, the incidence and risk factors for long-term complications (> 90 days) remain to be evaluated. We sought to identify the incidence, outcomes, and risk factors for long-term complications post-PD.
All PD survivors between 2010 and 2017 were identified from a single-institutional database. Long-term complications (> 90 days post-PD and not resulting from cancer recurrence), including biliary stricture, cholangitis, pancreatitis, peptic ulcer, small bowel obstruction, and incisional hernia, were identified. Logistic regression was used to identify perioperative predictors of long-term complications.
Of 906 PDs, 628 long-term survivors met criteria for analysis (mean age of 65.3 years, 47% female). Median follow-up and overall survival were 51.1 months (95% CI 47.6, 55.7) and 68.5 months (95% CI 57.9, 81.4), respectively. A total of 198 (31.5%) experienced at least one long-term complication. Complications included incisional hernia (17.7%), biliary stricture or cholangitis (8.0%), pancreatitis (5.7%), small bowel obstruction (4.3%), and peptic ulcer (3.2%). In total, 108 (17.2%) of the complications required an intervention, nearly half of which were surgical. On multivariable analysis, several predictors of long-term complications were identified: obesity (BMI ≥ 30 kg/m), postoperative wound infection, prolonged index length of stay, readmission (< 90 days), operative approach (open vs. robotic), and pylorus-preservation.
Long-term complications occur in nearly a third of PDs and nearly one-fifth of all PDs require re-intervention. Several modifiable predictors of long-term complications were identified.
胰十二指肠切除术（PD）后的长期并发症会显著影响生活质量和医疗保健的利用。大多数报告都集中在短期（90 天内）PD 结果上；然而，长期并发症（>90 天）的发生率和危险因素仍有待评估。我们旨在确定 PD 后长期并发症的发生率、结果和危险因素。
从单机构数据库中确定 2010 年至 2017 年间所有 PD 幸存者。确定了长期并发症（PD 后>90 天，且不是由癌症复发引起的），包括胆道狭窄、胆管炎、胰腺炎、消化性溃疡、小肠梗阻和切口疝。使用逻辑回归确定围手术期预测长期并发症的因素。
在 906 例 PD 中，有 628 例长期幸存者符合分析标准（平均年龄为 65.3 岁，47%为女性）。中位随访和总生存期分别为 51.1 个月（95%CI 47.6，55.7）和 68.5 个月（95%CI 57.9，81.4）。共有 198 例（31.5%）至少经历过一次长期并发症。并发症包括切口疝（17.7%）、胆道狭窄或胆管炎（8.0%）、胰腺炎（5.7%）、小肠梗阻（4.3%）和消化性溃疡（3.2%）。共有 108 例（17.2%）并发症需要干预，其中近一半需要手术。多变量分析确定了长期并发症的几个预测因素：肥胖（BMI≥30kg/m）、术后伤口感染、延长指数住院时间、再入院（<90 天）、手术途径（开放与机器人）和保留幽门。
近三分之一的 PD 患者发生长期并发症，近五分之一的 PD 患者需要再次干预。确定了一些可改变的长期并发症预测因素。
