Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Am J Surg. 2023 Feb;225(2):315-321. doi: 10.1016/j.amjsurg.2022.08.012. Epub 2022 Aug 30.
Patients with pancreas cancer may undergo palliative gastrointestinal or biliary bypass. Recent comparisons of post-operative outcomes following such procedures are lacking.
We analyzed patients undergoing exploration, gastrojejunostomy, biliary bypass or double bypass for pancreatic cancer using data from the 2005-2019 American College of Surgeons National Surgical Quality Improvement Program. We compared 30-day mortality and complications across procedures and over time periods (2005-10, 2011-14, 2015-19) using multivariable regression models. Factors associated with postoperative mortality were identified.
Of 43,525 patients undergoing surgery with a postoperative diagnosis of pancreatic cancer, 5572 met inclusion criteria. Palliative operations included 1037 gastrojejunostomies, 792 biliary bypasses, 650 double bypasses, and 3093 explorations. The proportion of biliary and double bypass procedures decreased from 2005-10 to 2015-19. Gastrojejunostomy had higher 30-day mortality rate (11.5%) than other operations (p < 0.001). Adjusted 30-day mortality rates remained stable over time (7.8% vs 6.3%, p = 0.095), while rates of serious complications decreased over time (23.2% vs 17.1%, p < 0.001).
Palliative bypass for pancreatic cancer has not become safer over time, and 30-day mortality and complications remain high.
胰腺癌患者可能需要进行姑息性胃肠或胆道旁路手术。目前缺乏这些手术后近期结果的比较数据。
我们利用美国外科医师学会国家手术质量改进计划 2005 年至 2019 年的数据，分析了接受胰腺探查、胃空肠吻合术、胆道旁路术或双旁路术的患者。我们使用多变量回归模型比较了不同手术方式和不同时间段（2005-10 年、2011-14 年、2015-19 年）的 30 天死亡率和并发症。确定了与术后死亡率相关的因素。
在 43525 例接受术后诊断为胰腺癌手术的患者中，有 5572 例符合纳入标准。姑息性手术包括 1037 例胃空肠吻合术、792 例胆道旁路术、650 例双旁路术和 3093 例探查术。胆道和双旁路手术的比例从 2005-10 年到 2015-19 年逐渐下降。胃空肠吻合术的 30 天死亡率（11.5%）高于其他手术（p<0.001）。调整后的 30 天死亡率在不同时间点保持稳定（7.8%比 6.3%，p=0.095），而严重并发症的发生率随时间下降（23.2%比 17.1%，p<0.001）。
随着时间的推移，胰腺癌姑息性旁路手术并没有变得更安全，30 天死亡率和并发症仍然很高。
