دورية أكاديمية
Impact of Neoadjuvant Treatment and Minimally Invasive Surgery on Perioperative Outcomes of Pancreatoduodenectomy: an ACS NSQIP Analysis.
| العنوان: | Impact of Neoadjuvant Treatment and Minimally Invasive Surgery on Perioperative Outcomes of Pancreatoduodenectomy: an ACS NSQIP Analysis. |
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| المؤلفون: | Al Abbas AI; University of Texas Southwestern, Department of Surgery, Dallas, TX, USA., Meier J; University of Texas Southwestern, Department of Surgery, Dallas, TX, USA., Hester CA; University of Texas Southwestern, Department of Surgery, Dallas, TX, USA., Radi I; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Yan J; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Zhu H; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Mansour JC; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Porembka MR; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Wang SC; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Yopp AC; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Zeh HJ 3rd; University of Texas Southwestern, Department of Surgery, Dallas, TX, USA.; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA., Polanco PM; University of Texas Southwestern, Department of Surgery, Dallas, TX, USA. Patricio.polanco@utsouthwestern.edu.; University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA. Patricio.polanco@utsouthwestern.edu.; Division of Surgical Oncology, University of Texas Southwestern Medical Center, 2201 Inwood Road, 3rd Floor, Dallas, TX, 75390, USA. Patricio.polanco@utsouthwestern.edu. |
| المصدر: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 Dec; Vol. 27 (12), pp. 2823-2842. Date of Electronic Publication: 2023 Oct 30. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier B.V Country of Publication: United States NLM ID: 9706084 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4626 (Electronic) Linking ISSN: 1091255X NLM ISO Abbreviation: J Gastrointest Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2024-: [Amsterdam] : Elsevier B.V. Original Publication: St. Louis, MO : Quality Medical Pub., c1997- |
| مواضيع طبية MeSH: | Pancreatic Neoplasms*/surgery , Laparoscopy*, Humans ; Pancreaticoduodenectomy/adverse effects ; Neoadjuvant Therapy ; Minimally Invasive Surgical Procedures/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Retrospective Studies |
| مستخلص: | Background: There is an increasing use of neoadjuvant treatment (NAT) for pancreatic cancer (PC) followed by minimally invasive pancreatoduodenectomy (MIPD). We evaluate the impact of the surgical approach on 30-day outcomes in PC patients who underwent NAT. Methods: Patients with PC who had NAT followed by MIPD or open pancreatoduodenectomy (OPD) were identified from a pancreatectomy-targeted dataset (2014-2020) of the National Surgical Quality Improvement Program. Comparisons were made between MIPD and OPD within NAT groups. Results: A total of 5588 patients were analyzed. Of those, 4907 underwent OPD and 476 underwent MIPD. In addition, 3559 patients received neoadjuvant chemotherapy alone and 1830 received neoadjuvant chemoradiation. In the chemotherapy-alone group, the MIPD subgroup had lower rates of any complication (38.2% vs. 45.8%, P = 0.005), but there were no differences in mortality (2.1% for MIPD vs 1.9% for OPD, P=0.8) or serious complication (11.8% for MIPD vs 15% for OPD, P=0.1). On multivariable analysis, MIPD was independently predictive of lower rates of any complication (OR: 0.74, 95% CI 0.6-0.93, P = 0.0009), CR-POPF (OR: 0.58, 95% CI 0.35-0.96, P = 0.04), and shorter LOS (estimate: -1.03, 95% CI -1.73 to -0.32, P = 0.004). In the chemoradiation group, patients undergoing MIPD had higher rates of preoperative diabetes (P < 0.05), but there were no significant differences in any outcomes between the two approaches in this group. Conclusion: MIPD is safe and feasible after NAT. Patients having neoadjuvant chemotherapy alone followed by MIPD had lower rates of complications, shorter LOS, and fewer CR-POPFs compared to OPD. (© 2023. The Society for Surgery of the Alimentary Tract.) |
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| فهرسة مساهمة: | Keywords: Neoadjuvant therapy; Operative approach; Pancreatoduodenectomy |
| تواريخ الأحداث: | Date Created: 20231031 Date Completed: 20240205 Latest Revision: 20240213 |
| رمز التحديث: | 20240213 |
| DOI: | 10.1007/s11605-023-05859-7 |
| PMID: | 37903972 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1873-4626 |
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| DOI: | 10.1007/s11605-023-05859-7 |