Surgical outcome of a double versus a single pancreatoduodenectomy per operating day

Autor: Rutger T. Theijse, Thomas F. Stoop, Niek J. Geerdink, Freek Daams, Babs M. Zonderhuis, Joris I. Erdmann, Rutger Jan Swijnenburg, Geert Kazemier, Olivier R. Busch, Marc G. Besselink
Přispěvatelé: Surgery, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, AGEM - Re-generation and cancer of the digestive system, AII - Cancer immunology, CCA - Cancer biology and immunology, CCA - Cancer Treatment and Quality of Life, Graduate School, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Imaging and biomarkers
Rok vydání: 2023
Předmět:
Zdroj: Surgery (United States), 173(5), 1263-1269. Mosby Inc.
Surgery, 173(5), 1263-1269. Mosby Inc.
Theijse, R T, Stoop, T F, Geerdink, N J, Daams, F, Zonderhuis, B M, Erdmann, J I, Swijnenburg, R J, Kazemier, G, Busch, O R & Besselink, M G 2023, ' Surgical outcome of a double versus a single pancreatoduodenectomy per operating day ', Surgery (United States), vol. 173, no. 5, pp. 1263-1269 . https://doi.org/10.1016/j.surg.2023.01.010
ISSN: 0039-6060
DOI: 10.1016/j.surg.2023.01.010
Popis: Background: For logistical reasons, some high-volume centers have developed surgical programs wherein 1 surgical team performs 2 pancreatoduodenectomies on a single day. It is unclear whether this practice has a negative impact on surgical outcome. Methods: We conuducted a retrospective analysis including all consecutive open pancreatoduodenectomies in a single high-volume center (2014–2021). Pancreatoduodenectomies were grouped as the first (pancreatoduodenectomy-1) or second (pancreatoduodenectomy-2) pancreatoduodenectomy on a single day (ie, paired pancreatoduodenectomies) and as pancreatoduodenectomy-3 whenever 1 pancreatoduodenectomy was performed per day (ie, unpaired). Patients undergoing minimally invasive procedures were excluded. The primary outcomes were major morbidity (ie, Clavien-Dindo grade ≥IIIa) and mortality. Results: Among 689 patients, 151 patients had undergone minimally invasive pancreatoduodenectomy, leaving 538 patients after open pancreatoduodenectomy for inclusion. The overall rate of major morbidity was 37.4% (n = 200/538) and in-hospital/30-day mortality 1.7% (n = 9/538). Overall, 136 (25.3%) patients were operated in 68 pancreatoduodenectomy-1/ pancreatoduodenectomy-2 pairs and 402 (74.7%) patients as unpaired pancreatoduodenectomy (pancreatoduodenectomy-3). No differences were found between pancreatoduodenectomy-1 and pancreatoduodenectomy-2 regarding the rates of major morbidity (35.3% vs 26.5%; P = .265) and mortality (1.5% vs 0%; P = .999). Between the 68 pancreatoduodenectomy-1/ pancreatoduodenectomy-2 pairs and the 402 unpaired pancreatoduodenectomies, the rates of major morbidity (30.9% vs 39.6%; P = .071) and mortality (0.7% vs 2.0%; P = .461) did not differ significantly. In multivariable logistic regression analysis, pancreatoduodenectomy-1 was not associated with major morbidity (odds ratio = 0.913 [95% confidence interval 0.515–1.620]; P = .756), whereas pancreatoduodenectomy-2 was associated with less major morbidity (odds ratio = 0.522 [95% confidence interval 0.277–0.983]; P = .045). Conclusion: In a high-volume setting, performing 2 consecutive open pancreatoduodenectomies on a single operating day appears to be safe. This approach may be an option when logistically required.
Databáze: OpenAIRE
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