Edge S B, Schmieg R E, Rosenlof L K, Wilhelm M C
Department of Surgery, University of Virginia School of Medicine, Charlottesville.
Cancer. 1993 Jun 1;71(11):3502-8. doi: 10.1002/1097-0142(19930601)71:11<3502::aid-cncr2820711107>3.0.co;2-n.
Series of patients with pancreas cancer from single high-volume institutions or surgeons have demonstrated improvements in morbidity and mortality of pancreatic resection in recent decades. The experience of these single institutions or surgeons may not, however, reflect the results achieved by a cross-section of surgeons or hospitals. This article examines the resection outcome for a large unselected group of university hospitals and surgeons.
Pancreas cancer resection morbidity and mortality were examined using a multi-institution data base of discharge coding data from 26 American university hospitals. The data were analyzed for relationships of morbidity and mortality with the type of resection, patient age, hospital volume, and individual surgeon case load.
Two hundred twenty-three resections were performed in 1989-1990 (pancreaticoduodenectomy, 168 patients; total pancreatectomy, 11; distal pancreatectomy, 30; and islet tumor resection, 14). The mortality rate was 6% (13 of 223) with major complications in 21%. Patient age did not correlate with complications or death. The surgeon case load ranged from 1-15 cases (median, 1) over the 2-year period. The mortality rate did not correlate with the case load. Surgeons performing one to three resections had significantly more complications than those performing four or more resections (P = 0.011).
Pancreas resection is performed by an unselected cross-section of surgeons in American university centers with acceptable morbidity and mortality rates.
近几十年来，来自单一高容量机构或外科医生的胰腺癌患者系列研究表明，胰腺切除术的发病率和死亡率有所改善。然而，这些单一机构或外科医生的经验可能无法反映不同外科医生或医院的整体结果。本文研究了一大组未经筛选的大学医院和外科医生的手术结果。
利用来自26家美国大学医院的出院编码数据多机构数据库，研究胰腺癌切除术的发病率和死亡率。分析发病率和死亡率与手术类型、患者年龄、医院手术量和个体外科医生手术例数之间的关系。
1989 - 1990年共进行了223例手术（胰十二指肠切除术168例；全胰切除术11例；胰体尾切除术30例；胰岛肿瘤切除术14例）。死亡率为6%（223例中的13例），主要并发症发生率为21%。患者年龄与并发症或死亡无关。在两年期间，外科医生的手术例数范围为1 - 15例（中位数为1例）。死亡率与手术例数无关。进行1 - 3例手术的外科医生比进行4例或更多例手术的外科医生并发症显著更多（P = 0.011）。
在美国大学中心，未经筛选的不同外科医生进行胰腺切除术，发病率和死亡率可接受。
