Lee Boram, Yoon Yoo-Seok, Kang Chang Moo, Choi Munseok, Lee Jun Suh, Hwang Ho Kyoung, Cho Jai Young, Lee Woo Jung, Han Ho-Seong
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea.
Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Hepatobiliary Pancreat Sci. 2021 Dec;28(12):1089-1097. doi: 10.1002/jhbp.866. Epub 2020 Nov 29.
To evaluate a risk-adjusted comparison of clinically relevant postoperative pancreatic fistula POPF (CR-POPF) following laparoscopic pancreatoduodenectomy (LPD) vs open pancreatoduodenectomy (OPD) using the fistula risk score (FRS).
We retrospectively analyzed 579 patients who underwent LPD (n = 274) or OPD (n = 305) between 2012 and 2019 at two tertiary hospitals. Using the FRS, the risk was stratified into four categories; negligible, low, intermediate and high risk.
The median FRS was significantly higher in the LPD than in the OPD group (5.4 ± 1.2 vs 3.9 ± 1.8, P < .001). The overall incidence of CR-POPF in the LPD vs OPD groups were 16.4% vs 17.7% (P = .187). When POPF risks were stratified by FRS, CR-POPF following LPD vs OPD in patients with low risk (0% vs 6.3%, P = .294), intermediate risk (16.1% vs 22.9%, P = .053) and high risk (33.3% vs 27.3%, P = .577) were not significantly different.
Despite a higher risk score in the LPD group, the CR-POPF was similar following both procedures in the unadjusted and FRS-risk-adjusted comparisons. The CR-POPF was more significantly affected by patient risk factors such as the soft pancreas and small pancreatic duct.
使用瘘管风险评分（FRS）评估腹腔镜胰十二指肠切除术（LPD）与开放胰十二指肠切除术（OPD）后临床相关术后胰瘘（CR-POPF）的风险调整比较。
我们回顾性分析了2012年至2019年期间在两家三级医院接受LPD（n = 274）或OPD（n = 305）的579例患者。使用FRS，将风险分为四类：可忽略不计、低、中、高风险。
LPD组的FRS中位数显著高于OPD组（5.4 ± 1.2 vs 3.9 ± 1.8，P <.001）。LPD组与OPD组CR-POPF的总体发生率分别为16.4%和17.7%（P =.187）。当按FRS对POPF风险进行分层时，低风险（0% vs 6.3%，P =.294）、中风险（16.1% vs 22.9%，P =.053）和高风险（33.3% vs 27.3%，P =.577）患者中LPD与OPD后的CR-POPF无显著差异。
尽管LPD组的风险评分较高，但在未调整和FRS风险调整比较中，两种手术方式后的CR-POPF相似。CR-POPF受胰腺质地软和胰管细小等患者风险因素的影响更大。
