登记员在微创远端胰腺切除术的表现及其对术后结果的影响。

Registrar performance in minimally invasive distal pancreatectomy and effects on postoperative outcomes.

机构信息

Department of Digestive Surgery and Transplantation, Montpellier University Hospital Center, University of Montpellier-Nimes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France.

Tumor Microenvironment and Resistance to Treatment Lab, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, 208 rue des Apothicaires, 34298, Montpellier Cedex 5, France.

出版信息

Langenbecks Arch Surg. 2021 Nov;406(7):2357-2365. doi: 10.1007/s00423-021-02212-x. Epub 2021 May 25.

DOI:10.1007/s00423-021-02212-x

PMID:34036406

Abstract

BACKGROUND

Minimally invasive distal pancreatectomy (MIDP) is nowadays an established standard procedure for non-locally advanced pancreatic lesions without celio-mesenteric vascular invasion. However, little is known about how the involvement of junior surgeons in MIDP affects postoperative outcomes. We performed a retrospective case series study in order to determine whether registrar involvement in MIDP is associated with adverse outcomes.

METHODS

Data were analyzed from a prospectively created database of consecutive patients undergoing MIDP. Only data from 91 patients who underwent MIDP for non-PDAC lesions were included. Patients were divided in 3 groups: Consultant P1 (first 20 MIDP, n=20), Consultant P2 (after 20 MIDP, n=44), and Registrar group (n=27). Conversion rates and 90-day postoperative outcomes were compared.

RESULTS

Conversion rates were 5%, 0%, and 14% in Consultant P1 and P2 and Registrar groups, respectively (P1 vs. P2, p = 0.312 and P1 vs. Registrar, p=0.376). Only Comprehensive Complication Index was higher in Registrar group compared to Consultant P1 group (13 vs. 3.7; p = 0.041). Comparison between Consultant P2 and Registrar groups resulted in a significant higher conversion rate (0 vs. 14%, p = 0.029), increased blood loss (77 vs. 263 ml, p = 0.018), and longer surgery duration (156 vs. 212 min, p=0.001) for registrars MIDP. However, no differences were found in clinically relevant postoperative pancreatic fistula (CR-POPF) (16 vs. 7.5%, p=0.282), Clavien-Dindo severe complication ≥3 score (11 vs. 4%, p=0.396), or length of hospital stay (9 vs. 9 days; p=0.614) between the consultant and registrar cohorts.

CONCLUSIONS

With all the limitations of a retrospective study with a small sample size, junior surgeons' involvement in MIDP for non-PDAC lesions resulted in higher conversion rate, blood loss and duration of surgery without statistically significant difference on clinical outcomes compared to a consultant.

摘要

背景

微创远端胰腺切除术（MIDP）现已成为无腹腔系膜血管侵犯的非局部进展性胰腺病变的标准治疗方法。然而，关于初级外科医生参与 MIDP 如何影响术后结果的了解甚少。我们进行了一项回顾性病例系列研究，以确定主治医生参与 MIDP 是否与不良结果相关。

方法

对连续接受 MIDP 治疗的患者进行前瞻性创建的数据库进行数据分析。仅纳入 91 例因非胰腺导管腺癌病变接受 MIDP 的患者数据。将患者分为 3 组：顾问 P1（前 20 例 MIDP，n=20）、顾问 P2（后 20 例 MIDP，n=44）和住院医师组（n=27）。比较中转率和 90 天术后结果。

结果

顾问 P1 和 P2 组及住院医师组的中转率分别为 5%、0%和 14%（P1 与 P2 相比，p=0.312；P1 与住院医师相比，p=0.376）。仅住院医师组的综合并发症指数（CCI）明显高于顾问 P1 组（13 比 3.7；p=0.041）。顾问 P2 组与住院医师组相比，中转率更高（0 比 14%，p=0.029），出血量更多（77 比 263ml，p=0.018），手术时间更长（156 比 212min，p=0.001）。然而，住院医师组的临床相关胰瘘（CR-POPF）（16 比 7.5%，p=0.282）、Clavien-Dindo 严重并发症≥3 评分（11 比 4%，p=0.396）或住院时间（9 比 9 天；p=0.614）无差异。