دورية أكاديمية
Nationwide Outcome after Pancreatoduodenectomy in Patients at very High Risk (ISGPS-D) for Postoperative Pancreatic Fistula.
| العنوان: | Nationwide Outcome after Pancreatoduodenectomy in Patients at very High Risk (ISGPS-D) for Postoperative Pancreatic Fistula. |
|---|---|
| المؤلفون: | Theijse RT; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Stoop TF; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands.; Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA., Hendriks TE; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands.; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Suurmeijer JA; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Smits FJ; Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital Nieuwegein, Utrecht University, the Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Lips DJ; Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands., Manusama E; Department of Surgery, Medisch Centrum Leeuwarden, the Netherlands., van der Harst E; Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands., Patijn GA; Department of Surgery, Isala Clinics, Zwolle, the Netherlands., Wijsman JH; Department of Surgery, Amphia Hospital, Breda, the Netherlands., Meerdink M; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands., den Dulk M; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.; Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Germany.; NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands., van Dam R; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.; Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Germany., Stommel MWJ; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands., van Laarhoven K; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands., de Wilde RF; Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands., Festen S; Department of Surgery, OLVG Oost, Amsterdam, the Netherlands., Draaisma WA; Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands., van Eijck CHJ; Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands., Busch OR; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Molenaar IQ; Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital Nieuwegein, Utrecht University, the Netherlands., Groot Koerkamp B; Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands., van Santvoort HC; Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital Nieuwegein, Utrecht University, the Netherlands., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands. |
| مؤلفون مشاركون: | Dutch Pancreatic Cancer Group |
| المصدر: | Annals of surgery [Ann Surg] 2023 Dec 11. Date of Electronic Publication: 2023 Dec 11. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0372354 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1140 (Electronic) Linking ISSN: 00034932 NLM ISO Abbreviation: Ann Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins |
| مستخلص: | Objective: To assess nationwide surgical outcome after pancreatoduodenectomy (PD) in patients at very high risk for postoperative pancreatic fistula (POPF), categorized as ISGPS-D. Summary Background Data: Morbidity and mortality after ISGPS-D PD is perceived so high that a recent randomized trial advocated prophylactic total pancreatectomy (TP) as alternative aiming to lower this risk. However, current outcomes of ISGPS-D PD remain unknown as large nationwide series are lacking. Methods: Nationwide retrospective analysis including consecutive patients undergoing ISGPS-D PD (i.e., soft texture and pancreatic duct ≤3 mm), using the mandatory Dutch Pancreatic Cancer Audit (2014-2021). Primary outcome was in-hospital mortality and secondary outcomes included major morbidity (i.e., Clavien-Dindo grade ≥IIIa) and POPF (ISGPS grade B/C). The use of prophylactic TP to avoid POPF during the study period was assessed. Results: Overall, 1402 patients were included. In-hospital mortality was 4.1% (n=57), which decreased to 3.7% (n=20/536) in the last 2 years. Major morbidity occurred in 642 patients (45.9%) and POPF in 410 (30.0%), which corresponded with failure to rescue in 8.9% (n=57/642). Patients with POPF had increased rates of major morbidity (88.0% vs. 28.3%; P<0.001) and mortality (6.3% vs. 3.5%; P=0.016), compared to patients without POPF. Among 190 patients undergoing TP, prophylactic TP to prevent POPF was performed in 4 (2.1%). Conclusion: This nationwide series found a 4.1% in-hospital mortality after ISGPS-D PD with 45.9% major morbidity, leaving little room for improvement through prophylactic TP. Nevertheless, given the outcomes in 30% of patients who develop POPF, future randomized trials should aim to prevent and mitigate POPF in this high-risk category. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.) |
| التعليقات: | Comment in: Gland Surg. 2024 Jun 30;13(6):1141-1143. doi: 10.21037/gs-24-86. (PMID: 39015713) |
| تواريخ الأحداث: | Date Created: 20231211 Latest Revision: 20240717 |
| رمز التحديث: | 20240717 |
| DOI: | 10.1097/SLA.0000000000006174 |
| PMID: | 38073575 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1140 |
|---|---|
| DOI: | 10.1097/SLA.0000000000006174 |