Depatment of Surgery, Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania. Street Emil Isac no 13, 400023, Cluj-Napoca-Napoca, Romania.
Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca-Napoca, Romania.
Langenbecks Arch Surg. 2022 Dec;407(8):3169-3192. doi: 10.1007/s00423-022-02702-6. Epub 2022 Oct 25.
Emergency pancreaticoduodenectomy (EPD) is an uncommon surgical procedure; usually, it is performed in traumatic cases, with non-traumatic indications being very rare. Our review aimed to offer a comprehensive descriptive overview of the characteristics of EPD in non-traumatic settings.
Our study is a review of individual participant data. PubMed, Cochrane, Google Scholar and Embase databases were searched. The last search was conducted in March 2022; studies that reported EPD for non-traumatic indications were included in the analysis.
Twenty-six articles were identified, twenty-five providing individual participant data; 17 articles (68%) were case reports. One article was a large retrospective study on the NSQIP (American College of Surgeons National Surgical Quality Improvement) database, which enrolled 409 patients that underwent EPD for malignant causes. From the other studies, we extracted individual participant data for a total of 66 patients. The patients were divided in subgroups, based on the indication for surgery: malignant causes (39.39%), uncontrollable bleeding (19.69%), iatrogenic injuries (30.3%), perforations (4.54%), or ischemic causes (6.06%). The postoperative morbidity was higher for the perforation subgroup. Postoperative pancreatic fistula is the most common complication reported (21.21%); higher rates were reported in the malignant and bleeding subgroups, with no special mention of this complication in the NSQIP database study. Mortality rate was 10.3% in the NSQIP database and higher, 19.69% in the 66-patient cohort; the highest mortality rates were registered in the perforation and ischemic subgroup.
EPD is a complex surgical intervention, with important associated morbidity and mortality rates, higher than that in elective settings, although it can be a life-saving procedure in selected cases and should be performed only in high-experience centres.
急诊胰十二指肠切除术（EPD）是一种不常见的手术方法；通常情况下，它是在创伤性病例中进行的，非创伤性适应证非常罕见。我们的综述旨在全面描述非创伤性情况下 EPD 的特征。
我们的研究是一项个体参与者数据的综述。检索了 PubMed、Cochrane、Google Scholar 和 Embase 数据库。最后一次检索是在 2022 年 3 月进行的；分析中纳入了报告非创伤性适应证行 EPD 的研究。
确定了 26 篇文章，其中 25 篇提供了个体参与者数据；17 篇文章（68%）为病例报告。有一篇文章是美国外科医师学会国家外科质量改进计划（NSQIP）数据库的大型回顾性研究，该研究纳入了 409 例因恶性原因行 EPD 的患者。从其他研究中，我们共提取了 66 例患者的个体参与者数据。根据手术适应证将患者分为亚组：恶性原因（39.39%）、无法控制的出血（19.69%）、医源性损伤（30.3%）、穿孔（4.54%）或缺血性原因（6.06%）。穿孔亚组的术后发病率较高。术后胰瘘是最常见的并发症（21.21%）；恶性和出血亚组的报告率较高，而 NSQIP 数据库研究中未特别提及该并发症。NSQIP 数据库研究中的死亡率为 10.3%，而在 66 例患者队列中则更高，为 19.69%；穿孔和缺血亚组的死亡率最高。
EPD 是一种复杂的手术干预，其相关发病率和死亡率均较高，高于择期手术，但在某些情况下可作为救命措施，且仅应在高经验中心进行。
