Chen Yuan, Wang Zhengwang, Chen Yuanyuan, Zhang Ke, Ge Xinyu, Zhu Jie, Wang Peng, Xu Qingcheng, Deng Denghao, Liu Jun, Xu Xiaolan, Chen Juan, Bai Dousheng, Xu Peng, Yao Jie
Department of Hepatobiliary and Pancreatic Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China.
Changzhou Hygiene Vocational Technology College, Changzhou, China.
Surg Endosc. 2025 Aug 25. doi: 10.1007/s00464-025-12113-5.
The objective of this study is to compare the clinical outcomes of endoscopic papillectomy (EP) and pancreatoduodenectomy (PD) for high-grade intraepithelial neoplasia of the duodenal papilla (HGIN-DP) and develop a preoperative risk prediction model for pathological upgrading.
Retrospective analysis of 92 patients (43 EP vs. 49 PD) treated between 2014 and 2023. Propensity score matching (1:1) balanced baseline characteristics, yielding 62 matched cases. Univariate and multivariate logistic regression analysis identified risk factors for pathological upgrading. A nomogram was developed and validated using patient data.
PD demonstrated superior 5-year overall survival (88.5% vs. 61.2%, P < 0.05) but longer operative time (230.0 vs. 41.0 min), higher blood loss (250.0 vs. 1.0 mL), prolonged hospitalization (27.0 vs. 8.0 days), increased costs (CNY 71,116.0 vs. 25,898.0), and higher delayed gastric emptying rates (35.5% vs. 3.2%) compared to EP. Postoperative pathological upgrading occurred in 51.2% (EP) and 69.4% (PD) of cases. Among them, 29.0% were diagnosed with adenocarcinoma in the EP group and 38.7% in the PD group. Multivariate analysis identified age (OR = 1.11), platelet count (OR = 1.02), and tumor size > 1 cm (OR = 21.79) as risk factors for pathological upgrading. A nomogram incorporating these predictors showed strong discriminative accuracy (AUC = 0.91 training, 0.86 validation).
EP offers advantages in recovery and cost, while PD remains preferable for HGIN-DP patients with high-risk features. The validated prediction model aids preoperative risk stratification, guiding personalized treatment decisions.
本研究旨在比较十二指肠乳头高级别上皮内瘤变（HGIN-DP）的内镜乳头切除术（EP）和胰十二指肠切除术（PD）的临床结局，并建立术前病理升级风险预测模型。
回顾性分析2014年至2023年期间治疗的92例患者（43例行EP，49例行PD）。倾向评分匹配（1:1）平衡了基线特征，产生62例匹配病例。单因素和多因素逻辑回归分析确定病理升级的危险因素。使用患者数据开发并验证了列线图。
与EP相比，PD显示出更好的5年总生存率（88.5%对61.2%，P<0.05），但手术时间更长（230.0对41.0分钟），失血量更多（250.0对1.0毫升），住院时间延长（27.0对8.0天），费用增加（71,116.0元对25,898.0元），延迟胃排空率更高（35.5%对3.2%）。术后病理升级发生率在EP组为51.2%，在PD组为69.4%。其中，EP组29.0%被诊断为腺癌，PD组38.7%被诊断为腺癌。多因素分析确定年龄（OR=1.11）、血小板计数（OR=1.02）和肿瘤大小>1 cm（OR=21.79）为病理升级的危险因素。纳入这些预测指标的列线图显示出较强的判别准确性（训练集AUC=0.91，验证集AUC=0.86）。
EP在恢复和成本方面具有优势，而对于具有高危特征的HGIN-DP患者，PD仍然是更可取的选择。经过验证的预测模型有助于术前风险分层，指导个性化治疗决策。
