Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of General, Visceral, Tumor, and Transplantation Surgery, University Hospital Cologne, Cologne, Germany.
JAMA Surg. 2022 Feb 1;157(2):120-128. doi: 10.1001/jamasurg.2021.5834.
Comparability of morbidity and mortality rates after total pancreatectomy (TP) reported by different surgical centers is limited. Procedure-specific differences, such as the extent of resection, including additional vascular or multivisceral resections, are rarely acknowledged when postoperative outcomes are reported.
To evaluate postoperative outcomes after TP and categorize different types of TP based on the extent, complexity, and technical aspects of each procedure.
DESIGN, SETTING, AND PARTICIPANTS: This single-center study included a retrospective cohort of 1451 patients who had undergone TP between October 1, 2001, and December 31, 2020. Each patient was assigned to 1 of the following 4 categories that reflect increasing levels of procedure-related difficulty: standard TP (type 1), TP with venous resection (type 2), TP with multivisceral resection (type 3), and TP with arterial resection (type 4). Postoperative outcomes among the groups were compared.
Categorization of different types of TP based on the procedure-related difficulty and differing postoperative outcomes.
Of the 1451 patients who had undergone TP and were included in the analysis, 840 were men (57.9%); median age was 64.9 (IQR, 56.7-71.7) years. A total of 676 patients (46.6%) were assigned to type 1, 296 patients (20.4%) to type 2, 314 patients (21.6%) to type 3, and 165 patients (11.4%) to type 4 TP. A gradual increase in surgical morbidity was noted by TP type (type 1: 255 [37.7%], type 2: 137 [46.3%], type 3: 178 [56.7%], and type 4: 98 [59.4%]; P < .001), as was noted for median length of hospital stay (type 1: 14 [IQR, 10-19] days, type 2: 16 [IQR, 12-23] days, type 3: 17 [IQR, 13-29] days, and type 4: 18 [IQR, 13-30] days; P < .001), and 90-day mortality (type 1: 23 [3.4%], type 2: 17 [5.7%], type 3: 29 [9.2%], and type 4: 20 [12.1%]; P < .001). In the multivariable analysis, type 3 (TP with multivisceral resection) and type 4 (TP with arterial resection) were independently associated with an increased 90-day mortality rate.
The findings of this study suggest there are significant differences in postoperative outcomes when the extent, complexity, and technical aspects of the procedure are considered. Classifying TP into 4 different categories may allow for better postoperative risk stratification as well as more accurate comparisons in future studies.
不同外科中心报告的全胰切除术（TP）后的发病率和死亡率的可比性有限。当报告术后结果时，很少承认手术特异性差异，例如切除的范围，包括额外的血管或多脏器切除。
评估 TP 后的术后结果，并根据每个手术的范围、复杂性和技术方面对不同类型的 TP 进行分类。
设计、地点和参与者：这是一项单中心研究，纳入了 2001 年 10 月 1 日至 2020 年 12 月 31 日期间接受 TP 的 1451 例患者的回顾性队列。每位患者被分配到以下 4 个类别之一，反映出与手术相关的难度增加：标准 TP（1 型）、静脉切除的 TP（2 型）、多脏器切除的 TP（3 型）和动脉切除的 TP（4 型）。比较各组之间的术后结果。
根据与手术相关的难度和不同的术后结果对不同类型的 TP 进行分类。
在接受 TP 并纳入分析的 1451 例患者中，840 例为男性（57.9%）；中位年龄为 64.9（IQR，56.7-71.7）岁。共有 676 例（46.6%）患者被分配到 1 型，296 例（20.4%）患者被分配到 2 型，314 例（21.6%）患者被分配到 3 型，165 例（11.4%）患者被分配到 4 型 TP。TP 类型的手术发病率逐渐增加（1 型：255[37.7%]，2 型：137[46.3%]，3 型：178[56.7%]，4 型：98[59.4%]；P < .001），中位住院时间也逐渐增加（1 型：14[IQR，10-19]天，2 型：16[IQR，12-23]天，3 型：17[IQR，13-29]天，4 型：18[IQR，13-30]天；P < .001），90 天死亡率也逐渐增加（1 型：23[3.4%]，2 型：17[5.7%]，3 型：29[9.2%]，4 型：20[12.1%]；P < .001）。多变量分析显示，3 型（多脏器切除的 TP）和 4 型（动脉切除的 TP）与 90 天死亡率增加独立相关。
这项研究的结果表明，当考虑手术的范围、复杂性和技术方面时，术后结果存在显著差异。将 TP 分为 4 个不同的类别，可能允许更好的术后风险分层，以及在未来的研究中更准确的比较。
