Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht, and St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands.
Br J Surg. 2021 Nov 11;108(11):1371-1379. doi: 10.1093/bjs/znab273.
Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy.
This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines.
From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P = 0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24 h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P = 0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84).
Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.
尽管经皮穿刺导管引流已成为标准治疗方法，但胰十二指肠切除术后发生胰瘘的一些患者最终仍需再次剖腹手术。本研究旨在比较胰十二指肠切除术后因胰瘘而行再次剖腹手术的患者中完成性胰腺切除术与保留胰腺手术的效果。
本研究为 9 家机构的回顾性队列研究，纳入 2005 年至 2018 年间因胰十二指肠切除术后胰瘘而行再次剖腹手术的患者。此外，根据 PRISMA 指南进行了系统评价和荟萃分析。
在 4877 例行胰十二指肠切除术的患者中，786 例（16%）发生 B/C 级胰瘘，162 例（3%）因胰瘘而行再次剖腹手术。这些患者中，36 例行完成性胰腺切除术，126 例行保留胰腺手术。完成性胰腺切除术后死亡率较高（20 例[56%]与 40 例[32%]；P=0.009），在调整再次剖腹手术前 24 小时的性别、年龄、BMI、ASA 评分、既往再次干预和器官衰竭等因素后，这种差异仍然存在（调整后的优势比 2.55，95%置信区间 1.07 至 6.08）。两组之间的附加再次干预比例无差异（23 例[64%]与 84 例[67%]；P=0.756）。纳入 33 项研究、评估 745 例患者的荟萃分析结果证实，完成性胰腺切除与死亡率之间存在关联（Mantel-Haenszel 随机效应模型：优势比 1.99，95%置信区间 1.03 至 3.84）。
根据目前的数据，在胰十二指肠切除术后因胰瘘而需要再次剖腹手术的患者中，保留胰腺手术似乎优于完成性胰腺切除术。
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