A propensity score analysis of over 12,000 pancreaticojejunal anastomoses after pancreaticoduodenectomy: does technique impact the clinically relevant fistula rate?
| Autor: | Ajay V. Maker, Lyonell B. Kone, Vijay K. Maker, Mihaela Banulescu |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Multivariate analysis Fistula medicine.medical_treatment 030230 surgery Anastomosis Pancreaticoduodenectomy Pancreatic Fistula 03 medical and health sciences Pancreatectomy 0302 clinical medicine Pancreaticojejunostomy medicine Humans Propensity Score Pancreatic duct Hepatology business.industry Gastroenterology Perioperative medicine.disease Surgery medicine.anatomical_structure Pancreatic fistula 030220 oncology & carcinogenesis Propensity score matching business |
| Zdroj: | HPB. 22:1394-1401 |
| ISSN: | 1365-182X |
| DOI: | 10.1016/j.hpb.2020.01.002 |
| Popis: | Background Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a major cause of morbidity in patients undergoing pancreatic surgery. Controversy exists as to whether there is any difference in CR-POPF with a Duct-to-Mucosa (DTM) versus an Invagination (IG) pancreaticojejunostomy (PJ). Methods Demographic, perioperative, intraoperative, and postoperative data were captured from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2014–2017 databases. Potential confounders were included in a logistic regression and a propensity score model. The primary outcome was CR-POPF. Results A total of 12,361 pancreaticojejunal anastomoses were performed with 11,168 patients undergoing DTM (90%) and 1193 undergoing IG (10%) after pancreaticoduodenectomy. Amongst all patients, there was no significant difference in CR-POPF between DTM and IG on multivariate (OR = 0.95, p = 0.64) or propensity score analysis (OR = 0.99, p = 0.93). After stratification by pancreatic gland texture and duct size, there was a decrease in CR-POPF with DTM amongst patients with duct size greater than 6 mm on multivariate analysis (OR = 0.35, p = 0.009) and propensity score analysis (OR = 0.40, p = 0.018). There were no significant differences in any other strata. Conclusion DTM or IG technique are not associated with CR-POPF for patients with average size pancreatic ducts; however, DTM is preferable in patients with large pancreatic duct diameter (>6 mm). |
| Databáze: | OpenAIRE |
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