Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China.
Surg Endosc. 2021 Dec;35(12):6472-6480. doi: 10.1007/s00464-020-08140-z. Epub 2020 Nov 6.
Postoperative complication rates after laparoscopic pancreaticoduodenectomy (LPD) remain high despite improvements in perioperative management. Measurements on computed tomography imaging of intra-abdominal tissue have not been thoroughly investigated as predictors of mortality and morbidity following LPD. The aim of this study was to assess whether the ratio of abdominal depth and body mass index (AD/BMI ratio) could predict postoperative complications following LPD.
We retrospectively analyzed 231 patients who underwent LPD and had a computed tomography scan between 2014 and 2018. Demographic, radiologic, and pathologic data were correlated to the occurrence of postoperative complications. Propensity score matching was performed to minimize selection biases associated with the comparison of retrospective data between the high and low AD/BMI ratio groups. Univariate and multivariate analyses were also performed to assess the risk factors for postoperative complications.
Of the 102 patients identified for propensity score matching analysis, 29 patients (28.4%) experienced postoperative complications. Patients with a high AD/BMI ratio had a higher prevalence of overall complications (45.1% vs. 11.8%, P < 0.001), postoperative pancreatic fistula (17.6% vs. 2.00%, P = 0.008), delayed gastric emptying (33.3% vs. 3.90%, P < 0.001), and intra-abdominal abscess (17.6% vs. 0, P = 0.002). In the multivariate analysis, an AD/BMI ratio greater than 2.7 (m/[kg·10]; OR = 6.16, 95% confidence interval [1.04-36.4], P = 0.045) was the only independent predictive factor of postoperative complications.
The preoperative AD/BMI ratio is a predictor of postoperative complications following LPD.
尽管围手术期管理有所改善，但腹腔镜胰十二指肠切除术（LPD）后的术后并发症发生率仍然很高。尽管对腹部组织的计算机断层扫描（CT）影像学测量尚未进行深入研究，但这些测量可能是预测 LPD 术后死亡率和发病率的因素。本研究旨在评估腹部深度与体重指数（AD/BMI）比值能否预测 LPD 后的术后并发症。
我们回顾性分析了 2014 年至 2018 年间接受 LPD 并接受 CT 扫描的 231 例患者。对人口统计学、影像学和病理学数据与术后并发症的发生进行了相关性分析。采用倾向评分匹配来最小化高 AD/BMI 比值组和低 AD/BMI 比值组之间回顾性数据比较的选择偏倚。还进行了单因素和多因素分析，以评估术后并发症的危险因素。
在 102 例接受倾向评分匹配分析的患者中，29 例（28.4%）发生了术后并发症。高 AD/BMI 比值组的总体并发症发生率较高（45.1% vs. 11.8%，P < 0.001），包括术后胰瘘（17.6% vs. 2.00%，P = 0.008）、胃排空延迟（33.3% vs. 3.90%，P < 0.001）和腹腔脓肿（17.6% vs. 0，P = 0.002）。多因素分析中，AD/BMI 比值大于 2.7（m/[kg·10]；OR = 6.16，95%置信区间 [1.04-36.4]，P = 0.045）是术后并发症的唯一独立预测因素。
术前 AD/BMI 比值是预测 LPD 术后并发症的指标。
