Evolution and improved outcomes in the era of multimodality treatment for extended pancreatectomy.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae065
Vikram A Chaudhari, Aditya R Kunte, Amit N Chopde, Vikas Ostwal, Anant Ramaswamy, Reena Engineer, Prabhat Bhargava, Munita Bal, Nitin Shetty, Suyash Kulkarni, Shraddha Patkar, Manish S Bhandare, Shailesh V Shrikhande
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Abstract

Background: The evolution and outcomes of extended pancreatectomies at a single institute over 15 years are presented in this study.

Methods: A retrospective analysis of the institutional database was performed from 2015 to 2022 (period B). Patients undergoing extended pancreatic resections, as defined by the International Study Group for Pancreatic Surgery, were included. Perioperative and survival outcomes were compared with data from 2007-2015 (period A). Regression analyses were used to identify factors affecting postoperative and long-term survival outcomes.

Results: A total of 197 (16.1%) patients underwent an extended resection in period B compared to 63 (9.2%) in period A. Higher proportions of borderline resectable (5 (18.5%) versus 51 (47.7%), P = 0.011) and locally advanced tumours (1 (3.7%) versus 24 (22.4%), P < 0.001) were resected in period B with more frequent use of neoadjuvant therapy (6 (22.2%) versus 79 (73.8%), P < 0.001). Perioperative mortality (4 (6.0%) versus 12 (6.1%), P = 0.81) and morbidity (23 (36.5%) versus 83 (42.1%), P = 0.57) rates were comparable. The overall survival for patients with pancreatic adenocarcinoma was similar in both periods (17.5 (95% c.i. 6.77 to 28.22) versus 18.3 (95% c.i. 7.91 to 28.68) months, P = 0.958). Resectable, node-positive tumours had a longer disease-free survival (DFS) in period B (5.81 (95% c.i. 1.73 to 9.89) versus 14.03 (95% c.i. 5.7 to 22.35) months, P = 0.018).

Conclusion: Increasingly complex pancreatic resections were performed with consistent perioperative outcomes and improved DFS compared to the earlier period. A graduated approach to escalating surgical complexity, multimodality treatment, and judicious patient selection enables the resection of advanced pancreatic tumours.

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扩展胰腺切除术多模式治疗时代的演变和更好的疗效。
背景:本研究介绍了 15 年来在一家医院进行的扩大胰腺切除术的演变和结果:本研究介绍了一家医疗机构 15 年来扩大胰腺切除术的演变和结果:对2015年至2022年(B期)的机构数据库进行了回顾性分析。根据国际胰腺外科研究小组的定义,纳入了接受扩大胰腺切除术的患者。围手术期和生存结果与 2007-2015 年(A 阶段)的数据进行了比较。通过回归分析确定影响术后和长期生存结果的因素:B期共有197例(16.1%)患者接受了扩大切除术,而A期为63例(9.2%)。011) 和局部晚期肿瘤(1 (3.7%) 对 24 (22.4%),P < 0.001)的切除率在 B 阶段更高,新辅助治疗的使用也更频繁(6 (22.2%) 对 79 (73.8%),P < 0.001)。围手术期死亡率(4(6.0%)对 12(6.1%),P = 0.81)和发病率(23(36.5%)对 83(42.1%),P = 0.57)相当。两个时期胰腺癌患者的总生存期相似(17.5(95% c.i.6.77至28.22)个月对18.3(95% c.i.7.91至28.68)个月,P = 0.958)。可切除的结节阳性肿瘤在B期的无病生存期(DFS)更长(5.81(95% 置信区间:1.73 至 9.89)个月对 14.03(95% 置信区间:5.7 至 22.35)个月,P = 0.018):结论:胰腺切除术越来越复杂,但围术期疗效一致,DFS较早期有所改善。手术复杂程度的逐步提高、多模式治疗以及对患者的审慎选择使晚期胰腺肿瘤的切除成为可能。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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