摘要
目的探究全胰切除术(total pancreatectomy,TP)与胰十二指肠切除术(pancreaticoduodenectomy,PD)治疗胰腺癌患者的术后短期并发症与长期预后差异。方法回顾性收集北京协和医院2016年1月至2021年12月行TP(TP组)和2019年1月至2021年12月行PD(PD组)的胰腺癌患者临床资料。根据危险因素的不同,将PD组患者分为胰瘘高风险PD组和复发高风险PD组。采用倾向性评分法匹配后,比较TP组与胰瘘高风险PD组、复发高风险PD组术后短期手术疗效指标(术后并发症发生率、30 d死亡率、住院时间等)、长期手术疗效指标(总生存期)及生活质量差异。结果共入选符合纳入与排除标准的TP组患者32例,PD组174例(胰瘘高风险PD组99例,复发高风险PD组15例)。(1)TP组与胰瘘高风险PD组:经倾向性评分匹配后,最终纳入TP组患者29例、胰瘘高风险PD组患者56例。TP组无胰瘘发生,胰瘘高风险PD组胰瘘发生率为19.64%(P=0.027),两组其他术后并发症发生率、Clavien-Dindo分级、住院时间、ICU停留时间、30 d死亡率等短期手术疗效指标均无统计学差异(P均>0.05)。中位随访时间36个月时,两组生命质量核心量表(quality of life questionnaire-core 30,QLQ-C30)评分均无显著差异(P均>0.05)。(2)TP组与复发高风险PD组:由于两组基线资料均无统计学差异(P均>0.05),故TP组32例患者、复发高风险PD组15例患者均纳入分析。TP组无胰瘘发生,复发高风险PD组胰瘘发生率为20.00%(P=0.028),两组其他术后并发症发生率、Clavien-Dindo分级、住院时间、ICU停留时间、30 d死亡率等短期手术疗效指标亦无统计学差异(P均>0.05)。截至末次随访,与复发高风险PD组比较,TP组中位总生存期更长(37.68个月比15.24个月,HR=2.551,95%CI:1.144~5.689,P=0.018);多因素Cox回归分析显示,复发高风险PD、术前合并梗阻性黄疸是胰腺癌患者长期预后不良的独立危险因素。结论对于胰瘘高风险胰腺癌患者,TP可取得与PD相当的短期手术疗效和长期生活质量,且术后无胰瘘负担。对于复发高风险胰腺癌患者,TP可在保证手术安全性的基础上显著延长患者生存期。
Objective To investigate the differences in postoperative short-term complications and long-term prognosis of pancreatic cancer(PC)patients after total pancreatectomy(TP)and pancreaticoduodenec-tomy(PD).Methods Clinical data of PC patients who underwent TP from January 2016 to December 2021(TP group)and PD from January 2019 to December 2021(PD group)at Peking Union Medical College Hos-pital were retrospectively collected.Patients in the PD group were divided into the pancreatic fistula(PF)high-risk PD group and the recurrence high-risk PD group according to risk factors.After propensity score matc-hing,the differences in postoperative short-term surgical efficacy indicators(postoperative complication rate,30 d mortality rate,length of hospital stay,etc.),long-term surgical efficacy indicators(overall survival),and quality of life were compared between the TP group and the PF high-risk PD group or the recurrence high-risk PD group.Results A total of 32 patients in the TP group and 114 patients in the PD group(99 patients in the PF high-risk PD group and 15 patients in the recurrence high-risk PD group)meeting the inclusion and exclusion criteria were enrolled.(1)TP group and PF high-risk PD group:after propensity score matching,29 patients in the TP group and 56 patients in the PF high-risk PD group were finally included.There was no PF in the TP group,and the rate of PF in the PF high-risk PD group was 19.64%(P=0.027).There were no statistical differences in short-term surgical efficacy indicators such as other postoperative complication rates,Clavien-Dindo grading,length of stay,ICU stay,and 30 d mortality between the two groups(all P>0.05).At the median follow-up time of 36 months,there was no significant difference in the quality of life questionnaire-core 30(QLQ-C30)scores between the two groups(P>0.05).(2)TP group and recurrent high-risk PD group:Since there were no statistically significant differences between the baseline data of the two groups(P>0.05),32 patients in the TP group and 15 patients in the recurrent high-risk PD group were both included in the analysis.There was no PF in the TP group,and the rate of PF in the recur-rent high-risk PD group was 20.00%(P=0.028).The other postoperative complication rates,Clavien-Dindo grading,length of hospital stay,ICU stay,30 d mortality and other short-term surgical efficacy indica-tors were also not statistically different between the two groups(all P>0.05).By the final follow-up,the median overall survival was longer in the TP group than the recurrent high-risk PD group(37.68 months vs.15.24 months,HR=2.551,95%CI:1.144-5.689,P=0.018).Multifactorial Cox regression showed that recurrent high-risk PD and preoperative obstructive jaundice were independent risk factors in the poor long-term prognosis of patients with PC.Conclusions For PC patients at high risk of PF,TP can achieve short-term surgical outcomes and long-term quality of life comparable to PD with no burden of postoperative pancreatic fistula.For patients with high-risk recurrence,TP can significantly prolong the survival of PC pa-tients while ensuring surgical safety.
作者
李天宇
赵邦博
李泽儒
赵宇彤
韩显林
张太平
戴梦华
郭俊超
王维斌
LI Tianyu;ZHAO Bangbo;LI Zeru;ZHAO Yutong;HAN Xianlin;ZHANG Taiping;DAI Menghua;GUO Junchao;WANG Weibin(Graduate School,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100005,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《协和医学杂志》
CSCD
北大核心
2024年第4期807-818,共12页
Medical Journal of Peking Union Medical College Hospital
基金
中央高水平医院临床科研专项(2022-PUMCH-B-004)。
关键词
胰腺癌
全胰切除术
胰十二指肠切除术
倾向性评分
术后并发症
生活质量
pancreatic cancer
total pancreatectomy
pancreaticoduodenectomy
propensity score
postoperative complica-tions
quality of life
