Department of Digestive Surgery and Transplantation, Claude Huriez University Hospital, Lille, France.
University of Lille, CNRS, Inserm, Lille University Hospital, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France.
Ann Surg. 2021 Nov 1;274(5):789-796. doi: 10.1097/SLA.0000000000005118.
Analyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate.
Despite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved.
All patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death.
Among the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality.
One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.
通过进行根本原因分析（RCA），分析法国高容量中心行胰腺切除术后死亡的多中心队列患者，以确定可避免死亡率。
尽管胰腺外科在一个多世纪以来取得了无可否认的进展，但术后结果仍然特别差，并且可以进一步改善。
纳入 2015 年 1 月至 2018 年 12 月期间行胰腺切除术且术后 90 天内死亡的所有患者。RCA 分 2 个阶段进行：第一阶段是从术前到死亡详细收集每位患者的数据，第二阶段是由独立专家委员会对文件进行盲法分析。通过识别可避免的死亡，定义了典型的死亡根本原因。
在 9 个参与中心行胰腺切除术的 3195 例患者中，140 例（4.4%）术后 90 天内死亡。排除 39 例患者后，对 101 例患者进行了分析。90%的病例确定了死亡原因。RCA 后，30%的病例死亡是可以预防的，主要是由于术前评估（疾病评估）或术后管理不足（尤其是胰瘘和出血）。10%的病例归咎于术中不当决策。比较分析表明，年轻和动脉切除，尤其是计划外动脉切除，常与可避免的死亡率相关。
胰腺切除术后三分之一的死亡率似乎是可以避免的，即使手术在高容量中心进行。这些数据表明，改善术后胰腺切除术结果需要多学科、严格和个性化的管理。
