Perioperative and oncologic outcomes after total pancreatectomy and pancreatoduodenectomy for pancreatic head adenocarcinoma—A propensity score–matched analysis from the German Cancer Registry Group

IF 2.7 2区医学 Q1 SURGERY Surgery Pub Date : 2025-05-01 Epub Date: 2025-03-17 DOI:10.1016/j.surg.2025.109292

Jannis Duhn MD , Lennart von Fritsch MD , Louisa Bolm MD , Rüdiger Braun MD , Kim Honselmann MD , Stanislav Litkevych MD , Markus Kist MD , Steffen Deichmann MD , Kees Kleihues-van Tol , Bianca Franke , Fabian Reinwald , Andrea Sackmann PhD , Bernd Holleczek MD , Anna Krauß , Monika Klinkhammer-Schalke MD , Sylke R. Zeissig MD , Tobias Keck MD, MBA, FACS , Ulrich F. Wellner MD , Thaer S.A. Abdalla MD

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Abstract

Background

To compare perioperative morbidity and mortality in patients receiving pancreatoduodenectomy or total pancreatectomy for pancreatic head adenocarcinoma using German Cancer Registry data.

Methods

Anonymized pooled data were retrieved from regional cancer registries participating in the German Cancer Registry Group of the Association of German Tumor Centers. Included were patients diagnosed with pancreatic head adenocarcinoma since 2016, receiving curative intent pancreatoduodenectomy or total pancreatectomy. Patients were propensity-score matched according to age, sex, and histopathology. Primary endpoints were 30- and 90-day postoperative mortality. Secondary endpoints were administration of adjuvant chemotherapy, long-term survival, and patterns of cancer recurrence. The data were analyzed using R.

Results

In total, 756 patients per treatment group were matched for further analyses. R0-resection rate was comparable between pancreatoduodenectomy and total pancreatectomy (69.6 vs 73.4%, P = .154). The 30-day (9.5 vs 4.8%, P < .001) and 90-day postoperative mortality (18.0 vs 11.0%, P < .001) rates were significantly lower after pancreatoduodenectomy compared with total pancreatectomy. After pancreatoduodenectomy, more patients received adjuvant chemotherapy (43.6 vs 53.3%, P < .001) and time to adjuvant chemotherapy was shorter (60.1 vs 52.7 days, P = .002) compared with total pancreatectomy. Long-term overall survival was worse after total pancreatectomy (P < .001), also in patients receiving adjuvant chemotherapy (P = .019). The sites of recurrence were comparable between both groups (P = .274).

Conclusion

The results of this study show greater perioperative morbidity and mortality after total pancreatectomy compared with pancreatoduodenectomy for pancreatic head malignancy. Also, long-term survival was worse after total pancreatectomy. These results emphasize the role of pancreatoduodenectomy as a standard surgical procedure for pancreatic head adenocarcinoma and suggest that total pancreatectomy should only be performed in selected patients.

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全胰切除术和胰十二指肠切除术治疗胰头腺癌的围手术期和肿瘤预后——来自德国癌症登记组的倾向评分匹配分析

背景：利用德国癌症登记处的数据，比较接受胰十二指肠切除术或全胰切除术治疗胰头腺癌患者的围手术期发病率和死亡率。方法从参与德国肿瘤中心协会德国癌症登记组的区域癌症登记中检索匿名汇总数据。纳入自2016年以来诊断为胰头腺癌的患者，接受治愈性胰十二指肠切除术或全胰切除术。根据年龄、性别和组织病理学对患者进行倾向评分匹配。主要终点为术后30天和90天死亡率。次要终点是辅助化疗的实施、长期生存和癌症复发模式。结果每个治疗组共匹配756例患者进行进一步分析。胰十二指肠切除术和全胰切除术的r0切除率相当（69.6 vs 73.4%, P = 0.154）。30天期指数（9.5% vs 4.8%）；.001)和术后90天死亡率(18.0 vs 11.0%, P <；.001)与全胰切除术相比，胰十二指肠切除术后的发生率显著降低。胰十二指肠切除术后接受辅助化疗的患者较多(43.6% vs 53.3%, P <；与全胰切除术相比，辅助化疗时间更短（60.1天vs 52.7天，P = 0.002）。全胰切除术后长期总生存率较差(P <；.001)，接受辅助化疗的患者也是如此（P = .019）。两组复发部位具有可比性（P = 0.274）。结论胰头恶性肿瘤全胰切除术围手术期发病率和死亡率高于胰十二指肠切除术。此外，全胰切除术后的长期生存率更差。这些结果强调了胰十二指肠切除术作为胰头腺癌的标准外科手术的作用，并建议全胰切除术只应在选定的患者中进行。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.