文章：

不同壶腹周围类型及亚型导致胰十二指肠切除术围手术期结局差异：现实而非神话；一项国际多中心队列研究

Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study

原文发布日期：23 February 2024

DOI: 10.3390/cancers16050899

类型: Article

开放获取: 是

英文摘要：

This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major morbidity (Clavien-Dindo 3b≥), clinically relevant post-operative pancreatic fistula (CR-POPF), and length of hospital stay (LOS). Results: Overall, 3622 patients were included in the study (370 DAC, 811 AmpIT, 895 AmpPB, 1083 dCCA, and 463 PDAC). Mortality rates were comparable between DAC, AmpIT, AmpPB, and dCCA (ranging from 3.7% to 5.9%), while lower for PDAC (1.5%,p= 0.013). Major morbidity rate was the lowest in PDAC (4.4%) and the highest for DAC (19.9%,p< 0.001). The highest rates of CR-POPF were observed in DAC (27.3%), AmpIT (25.5%), and dCCA (27.6%), which were significantly higher compared to AmpPB (18.5%,p= 0.001) and PDAC (8.3%,p< 0.001). The shortest LOS was found in PDAC (11 d vs. 14–15 d,p< 0.001). Discussion: In conclusion, this study shows significant variations in perioperative mortality, post-operative complications, and hospital stay among different periampullary cancers, and between the ampullary subtypes. Further research should assess the biological characteristics and tissue reactions associated with each type of periampullary cancer, including subtypes, in order to improve patient management and personalized treatment.

摘要翻译： 

这项国际多中心队列研究纳入了30个中心。研究对象包括十二指肠腺癌（DAC）、肠型（AmpIT）与胰胆管型（AmpPB）壶腹腺癌、远端胆管癌（dCCA）以及胰腺导管腺癌（PDAC）患者。主要结局指标为30天或住院期间死亡率，次要结局指标包括主要并发症（Clavien-Dindo分级≥3b级）、临床相关术后胰瘘（CR-POPF）及住院时长（LOS）。结果：研究共纳入3622例患者（370例DAC、811例AmpIT、895例AmpPB、1083例dCCA及463例PDAC）。DAC、AmpIT、AmpPB和dCCA的死亡率相近（3.7%-5.9%），而PDAC死亡率显著较低（1.5%，p=0.013）。主要并发症发生率在PDAC中最低（4.4%），在DAC中最高（19.9%，p<0.001）。CR-POPF发生率在DAC（27.3%）、AmpIT（25.5%）和dCCA（27.6%）中最高，显著高于AmpPB（18.5%，p=0.001）和PDAC（8.3%，p<0.001）。PDAC患者住院时长最短（11天 vs. 14-15天，p<0.001）。讨论：本研究显示不同壶腹周围癌及壶腹亚型在围手术期死亡率、术后并发症和住院时长方面存在显著差异。未来研究应深入评估各类壶腹周围癌（包括亚型）的生物学特性及组织反应特征，以优化患者管理和个体化治疗策略。

原文链接：

Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study