Wang Haikuo, Hu Xiao, Yin Changjun, Zhou Dejiang, Li Zonglin, Ma Zifeng, Zhang Heyun
Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Transl Gastroenterol Hepatol. 2024 Jul 11;9:38. doi: 10.21037/tgh-23-112. eCollection 2024.
Assessing the perioperative outcomes of pancreaticoduodenectomy (PD) based solely on individual complications is not comprehensive, and the association between perioperative outcomes and the long-term prognosis of individuals diagnosed with pancreatic ductal adenocarcinoma (PDAC) remains uncertain. Our study is designed to evaluate the impact of a novel composite indicator, textbook outcomes (TO), on the long-term prognosis of patients undergoing PD for PDAC.
This study conducted a retrospective analysis of 139 patients who underwent PD for pathologically confirmed PDAC at our hospital between January 2018 and December 2021. After applying exclusion criteria, a total of 111 patients were included in the subsequent analysis. These patients were categorized into two groups: the non-TO group (n=42) and the TO group (n=69). The Kaplan-Meier survival curve was employed to describe the relationship between TO and disease-free survival (DFS) and overall survival (OS). Cox regression was employed to assess the impact of achieving TO on long-term survival. Logistic regression was employed to investigate the risk factors affecting the achievement of TO.
Out of the 111 PDAC patients, 69 (62.2%) achieved TO following PD. The achievement of TO significantly improved the OS of PDAC patients [P=0.03; hazard ratio (HR) =0.60; 95% confidence interval (CI): 0.37-0.83]. Cox regression analysis indicated that achieving TO was a protective factor for OS (P=0.04; HR =4.08; 95% CI: 1.07-15.61). Logistic regression analysis indicated that high amylase in drainage fluid on the third day after surgery (>1,300 U/L) was detrimental to achieve TO [odds ratio (OR) =0.10; 95% CI: 0.02-0.58; P=0.01], longer surgery durations (≥6.25 hours) was detrimental to achieve TO (OR =0.19; 95% CI: 0.06-0.54; P=0.002), and soft pancreatic texture was detrimental to achieve TO (OR =0.31; 95% CI: 0.10-0.93, P=0.04).
Achievement of TO significantly improves the OS of PDAC patients and has the potential to serve as a robust prognostic indicator. Looking ahead, it is highly necessary for TO to become a standard surgical quality control measure in hospitals.
仅基于个体并发症来评估胰十二指肠切除术（PD）的围手术期结果并不全面，且围手术期结果与胰腺导管腺癌（PDAC）患者长期预后之间的关联仍不明确。我们的研究旨在评估一种新的综合指标——教科书式结果（TO）对接受PD治疗的PDAC患者长期预后的影响。
本研究对2018年1月至2021年12月期间在我院接受PD治疗且病理确诊为PDAC的139例患者进行了回顾性分析。应用排除标准后，共有111例患者纳入后续分析。这些患者被分为两组：非TO组（n = 42）和TO组（n = 69）。采用Kaplan-Meier生存曲线描述TO与无病生存期（DFS）和总生存期（OS）之间的关系。采用Cox回归评估实现TO对长期生存的影响。采用Logistic回归研究影响实现TO的危险因素。
111例PDAC患者中，69例（62.2%）在PD后实现了TO。实现TO显著改善了PDAC患者的OS[P = 0.03；风险比（HR）= 0.60；95%置信区间（CI）：0.37 - 0.83]。Cox回归分析表明，实现TO是OS的保护因素（P = 0.04；HR = 4.08；95% CI：1.07 - 15.61）。Logistic回归分析表明，术后第三天引流液中淀粉酶水平高（>1300 U/L）不利于实现TO[比值比（OR）= 0.10；95% CI：0.02 - 0.58；P = 0.01]，手术时间长（≥6.25小时）不利于实现TO（OR = 0.19；95% CI：0.06 - 0.54；P = 0.002），胰腺质地软不利于实现TO（OR = 0.31；95% CI：0.10 - 0.93，P = 0.04）。
实现TO显著改善了PDAC患者的OS，并有潜力作为一个可靠的预后指标。展望未来，TO成为医院标准的手术质量控制措施非常必要。
