Surgical Outcome After Pancreatoduodenectomy for Duodenal Adenocarcinoma Compared with Other Periampullary Cancers: A Nationwide Audit Study.

Autor: de Bakker JK; Amsterdam UMC, Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Amsterdam, The Netherlands., Suurmeijer JA; Cancer Center Amsterdam, Amsterdam, The Netherlands.; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands., Toennaer JGJ; Amsterdam UMC, Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Amsterdam, The Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Busch OR; Cancer Center Amsterdam, Amsterdam, The Netherlands.; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands., van Eijck CH; Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., de Hingh IH; Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands., de Meijer VE; Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Molenaar IQ; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center, Utrecht, The Netherlands., van Santvoort HC; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center, Utrecht, The Netherlands., Stommel MW; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Festen S; Department of Surgery, OLVG, Amsterdam, The Netherlands., van der Harst E; Department of Surgery, Maasstadziekenhuis, Rotterdam, The Netherlands., Patijn G; Department of Surgery, Isala Clinics, Zwolle, The Netherlands., Lips DJ; Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Den Dulk M; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch ziekenhuis, Den Bosch, The Netherlands., Besselink MG; Cancer Center Amsterdam, Amsterdam, The Netherlands. m.besselink@amsterdamUMC.nl.; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands. m.besselink@amsterdamUMC.nl., Kazemier G; Amsterdam UMC, Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands. g.kazemier@amsterdamUMC.nl.; Cancer Center Amsterdam, Amsterdam, The Netherlands. g.kazemier@amsterdamUMC.nl.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2023 Apr; Vol. 30 (4), pp. 2448-2455. Date of Electronic Publication: 2022 Dec 19.
DOI: 10.1245/s10434-022-12701-y
Abstrakt: Background: Surgical outcome after pancreatoduodenectomy for duodenal adenocarcinoma could differ from pancreatoduodenectomy for other cancers, but large multicenter series are lacking. This study aimed to determine surgical outcome in patients after pancreatoduodenectomy for duodenal adenocarcinoma, compared with other periampullary cancers, in a nationwide multicenter cohort.
Methods: After pancreatoduodenectomy for cancer between 2014 and 2019, consecutive patients were included from the nationwide, mandatory Dutch Pancreatic Cancer Audit. Patients were stratified by diagnosis. Baseline, treatment characteristics, and postoperative outcome were compared between groups. The association between diagnosis and major complications (Clavien-Dindo grade III or higher) was assessed via multivariable regression analysis.
Results: Overall, 3113 patients, after pancreatoduodenectomy for cancer, were included in this study: 264 (8.5%) patients with duodenal adenocarcinomas and 2849 (91.5%) with other cancers. After pancreatoduodenectomy for duodenal adenocarcinoma, patients had higher rates of major complications (42.8% vs. 28.6%; p < 0.001), postoperative pancreatic fistula (International Study Group of Pancreatic Surgery [ISGPS] grade B/C; 23.1% vs. 13.4%; p < 0.001), complication-related intensive care admission (14.3% vs. 10.3%; p = 0.046), re-interventions (39.8% vs. 26.6%; p < 0.001), in-hospital mortality (5.7% vs. 3.1%; p = 0.025), and longer hospital stay (15 days vs. 11 days; p < 0.001) compared with pancreatoduodenectomy for other cancers. In multivariable analysis, duodenal adenocarcinoma was independently associated with major complications (odds ratio 1.14, 95% confidence interval 1.03-1.27; p = 0.011).
Conclusion: Pancreatoduodenectomy for duodenal adenocarcinoma is associated with higher rates of major complications, pancreatic fistula, re-interventions, and in-hospital mortality compared with patients undergoing pancreatoduodenectomy for other cancers. These findings should be considered in patient counseling and postoperative management.
(© 2022. The Author(s).)
Databáze: MEDLINE
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