Department of General- and Visceral Surgery, University of Freiburg Medical Center, Faculty of Medicine, Freiburg, Germany.
Current address: Clinic for General-, Visceral- and Vascular Surgery, Fürst-Stirum-Klinik, Bruchsal, Germany.
Langenbecks Arch Surg. 2024 Apr 17;409(1):129. doi: 10.1007/s00423-024-03319-7.
Pancreatoduodenectomies are complex surgical procedures with a considerable morbidity and mortality even in high-volume centers. However, postoperative morbidity and long-term oncological outcome are not only affected by the surgical procedure itself, but also by the underlying disease. The aim of our study is an analysis of pancreatoduodenectomies for patients with pancreatic ductal adenocarcinoma (PDAC) and ampullary carcinoma (CAMP) concerning postoperative complications and long-term outcome in a tertiary hospital in Germany.
The perioperative and oncological outcome of 109 pancreatic head resections performed for carcinoma of the ampulla vateri was compared to the outcome of 518 pancreatic head resections for pancreatic ductal adenocarcinoma over a 20 year-period from January 2002 until December 2021. All operative procedures were performed at the University Hospital Freiburg, Germany. Patient data was analyzed retrospectively, using a prospectively maintained SPSS database. Propensity score matching was performed to adjust for differences in surgical and reconstruction technique. Primary outcome of our study was long-term overall survival, secondary outcomes were postoperative complications and 30-day postoperative mortality. Postoperative complications like pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) were graded following current international definitions. Survival was estimated using Kaplan Meier curves and log-rank tests. A p-value < 0.05 was considered statistically significant.
Operation time was significantly longer in PDAC patients (432 vs. 391 min, p < 0.001). The rate of portal vein resections was significantly higher in PDAC patients (p < 0.001). In CAMP patients, a pancreatogastrostomy as reconstruction technique was performed more frequently compared to PDAC patients (48.6% vs. 29.9%, p < 0.001) and there was a trend towards more laparoscopic surgeries in CAMP patients (p = 0.051). After propensity score matching, we found no difference in DGE B/C and PPH B/C (p = 0.389; p = 0.517), but a significantly higher rate of clinically relevant pancreatic fistula (CR-POPF) in patients with pancreatoduodenectomies due to ampullary carcinoma (30.7% vs. 16.8%, p < 0.001). Long-term survival was significantly better in CAMP patients (42 vs. 24 months, p = 0.003).
Patients with pancreatoduodenectomies due to ampullary carcinomas showed a better long-term oncological survival, by reason of the better prognosis of this tumor entity. However, these patients often needed a more elaborated postoperative treatment due to the higher rate of clinically relevant pancreatic fistula in this group.
胰十二指肠切除术是一种复杂的手术，即使在高容量中心，其发病率和死亡率也相当高。然而，术后发病率和长期肿瘤学结果不仅受手术本身的影响，还受基础疾病的影响。我们研究的目的是分析德国一家三级医院因胰头腺癌（PDAC）和壶腹癌（CAMP）行胰十二指肠切除术患者的术后并发症和长期结果。
比较了 2002 年 1 月至 2021 年 12 月期间，109 例因壶腹 Vater 癌行胰头切除术与 518 例因胰腺导管腺癌行胰头切除术的围手术期和肿瘤学结果。所有手术均在德国弗赖堡大学医院进行。使用前瞻性维护的 SPSS 数据库回顾性分析患者数据。采用倾向评分匹配来调整手术和重建技术的差异。我们研究的主要结果是长期总体生存率，次要结果是术后并发症和 30 天术后死亡率。根据当前国际定义，对术后并发症（如胰瘘、胰腺术后出血和胃排空延迟）进行分级。使用 Kaplan-Meier 曲线和对数秩检验估计生存率。p 值<0.05 被认为具有统计学意义。
PDAC 患者的手术时间明显更长（432 分钟 vs. 391 分钟，p<0.001）。PDAC 患者门静脉切除率明显更高（p<0.001）。与 PDAC 患者相比，CAMP 患者更常采用胰胃吻合术作为重建技术（48.6% vs. 29.9%，p<0.001），并且 CAMP 患者的腹腔镜手术比例呈上升趋势（p=0.051）。经过倾向评分匹配后，我们发现胰十二指肠切除术患者的 DGE B/C 和 PPH B/C 差异无统计学意义（p=0.389;p=0.517），但壶腹癌患者的临床相关胰瘘（CR-POPF）发生率明显更高（30.7% vs. 16.8%，p<0.001）。CAMP 患者的长期生存率明显更好（42 个月 vs. 24 个月，p=0.003）。
因壶腹癌而行胰十二指肠切除术的患者，由于该肿瘤实体的预后较好，其长期肿瘤学生存情况明显更好。然而，由于该组患者临床相关胰瘘的发生率较高，因此他们通常需要更复杂的术后治疗。
