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Magnetic versus conventional stent in ureteral stenting: meta-analysis. 输尿管支架植入术中的磁性支架与传统支架:荟萃分析。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae086
Zhunan Xu, Hang Zhou, Qihua Wang, Congzhe Ren, Yang Pan, Shangren Wang, Li Liu, Xiaoqiang Liu
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引用次数: 0
BJS and BJS Open correspondence to move to the BJS Academy. 北京和睦家医院和北京和睦家医院开放函授转入北京和睦家医院学院。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae077
Ville Sallinen, Desmond C Winter, Jonothan J Earnshaw
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引用次数: 0
Association of resilience and psychological flexibility with surgeons' mental wellbeing. 复原力和心理灵活性与外科医生心理健康的关系。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae060
Maddy Greville-Harris, Catherine Withers, Agata Wezyk, Kevin Thomas, Helen Bolderston, Amy Kane, Sine McDougall, Kevin J Turner

Background: Existing research highlights the link between certain personality traits and mental health in surgeons. However, little research has explored the important role of psychological skills and qualities in potentially explaining this link. A cross-sectional survey of UK-based surgeons was used to examine whether two such skills (psychological flexibility and resilience) helped to explain why certain personality traits might be linked to mental health in surgeons.

Method: An online survey comprising measures of personality (neuroticism, extraversion and conscientiousness), psychological skills/qualities (psychological flexibility and resilience) and mental health (depression, anxiety, stress and burnout) was sent to surgeons practising in the UK. Mediation analyses were used to examine the potential mediating role of psychological flexibility and resilience in explaining the relationship between personality factors and mental health.

Results: A total of 348 surgeons completed the survey. In all 12 mediation models, psychological flexibility and/or resilience played a significant role in explaining the relationship between personality traits (neuroticism, extraversion and conscientiousness) and mental health (depression, anxiety and burnout).

Conclusion: Findings suggest that it is not only a surgeon's personality that is associated with their mental health, but the extent to which a surgeon demonstrates specific psychological qualities and skills (psychological flexibility and resilience). This has important implications for improving surgeons' mental wellbeing, because psychological flexibility and resilience are malleable, and can be successfully targeted with interventions in a way that personality traits cannot.

背景:现有研究强调了外科医生的某些个性特征与心理健康之间的联系。然而,很少有研究探讨心理技能和素质在潜在解释这种联系方面的重要作用。我们对英国的外科医生进行了一项横断面调查,以研究两种此类技能(心理灵活性和复原力)是否有助于解释为什么某些人格特质可能与外科医生的心理健康有关:方法:我们向在英国执业的外科医生发送了一份在线调查,内容包括人格测量(神经质、外向性和自觉性)、心理技能/素质(心理灵活性和复原力)和心理健康(抑郁、焦虑、压力和职业倦怠)。通过中介分析,研究了心理灵活性和复原力在解释人格因素与心理健康之间的关系时可能起到的中介作用:共有 348 名外科医生完成了调查。在所有 12 个中介模型中,心理灵活性和/或复原力在解释人格特质(神经质、外向性和自觉性)与心理健康(抑郁、焦虑和职业倦怠)之间的关系方面发挥了重要作用:研究结果表明,外科医生的心理健康不仅与他们的性格有关,还与外科医生在多大程度上表现出特定的心理素质和技能(心理灵活性和适应能力)有关。这对改善外科医生的心理健康具有重要意义,因为心理灵活性和恢复力具有可塑性,可以成功地针对其进行干预,而人格特质则无法做到这一点。
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引用次数: 0
Prophylactic negative pressure wound therapy (NPWT) in laparotomy wounds (PROPEL-2): protocol for a randomized clinical trial. 开腹手术伤口预防性负压疗法(NPWT)(PROPEL-2):随机临床试验方案。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae081
Matthew G Davey, Noel E Donlon, Stewart R Walsh, Claire L Donohoe

Background: A proportion of patients undergoing midline laparotomy will develop surgical site infections after surgery. These complications place considerable financial burden on healthcare economies and have negative implications for patient health and quality of life. The prophylactic application of negative pressure wound therapy devices has been mooted as a pragmatic strategy to reduce surgical site infections. Nevertheless, further availability of multicentre randomized clinical trial data evaluating the prophylactic use of negative pressure wound therapy following midline laparotomy is warranted to definitely provide consensus in relation to these closure methods, while also deciphering potential differences among subgroups. The aim of this study is to determine whether prophylactic negative pressure wound therapy reduces postoperative wound complications in patients undergoing midline laparotomy.

Methods: PROPEL-2 is a multicentre prospective randomized clinical trial designed to compare standard surgical dressings (control arm) with negative pressure wound therapy dressings (Prevena™ and PICO™ being the most commonly utilized). Patient recruitment will include adult patients aged 18 years or over, who are indicated to undergo emergency or elective laparotomy. To achieve 90% power at the 5% significance level, 1006 patients will be required in each arm, which when allowing for losses to follow-up, 10% will be added to each arm, leaving the total projected sample size to be 2013 patients, who will be recruited across a 36-month enrolment period.

Conclusion: The PROPEL-2 trial will be the largest independent multicentre randomized clinical trial designed to assess the role of prophylactic negative pressure wound therapy in patients indicated to undergo midline laparotomy. The comparison of standard treatment to two commercially available negative pressure wound therapy devices will help provide consensus on the routine management of laparotomy wounds. Enrolment to PROPEL-2 began in June 2023. Registration number: NCT05977816 (http://www.clinicaltrials.gov).

背景:一部分接受中线开腹手术的患者会在术后发生手术部位感染。这些并发症给医疗经济造成了巨大的经济负担,并对患者的健康和生活质量产生了负面影响。预防性应用负压伤口治疗设备被认为是减少手术部位感染的实用策略。尽管如此,仍有必要进一步提供多中心随机临床试验数据,对中线开腹手术后预防性使用负压伤口疗法进行评估,以便就这些闭合方法达成共识,同时解读亚组之间的潜在差异。本研究旨在确定预防性负压伤口疗法是否能减少中线开腹手术患者的术后伤口并发症:PROPEL-2 是一项多中心前瞻性随机临床试验,旨在比较标准手术敷料(对照组)和负压伤口治疗敷料(Prevena™ 和 PICO™ 是最常用的敷料)。患者招募将包括年龄在 18 周岁或以上、有接受急诊或择期开腹手术指征的成年患者。为了在5%的显著性水平下达到90%的功率,每组需要1006名患者,如果考虑到随访损失,每组将增加10%,因此预计样本总数为2013名患者,招募期为36个月:PROPEL-2试验将是规模最大的独立多中心随机临床试验,旨在评估预防性负压伤口疗法在中线开腹手术患者中的作用。将标准治疗与两种市售负压伤口治疗设备进行比较,将有助于就开腹手术伤口的常规管理达成共识。PROPEL-2 于 2023 年 6 月开始注册。注册号NCT05977816 (http://www.clinicaltrials.gov)。
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引用次数: 0
Supporting a diverse surgeon workforce: embracing personality and supporting psychological resilience to improve surgeon health and wellbeing. 支持多样化的外科医生队伍:接纳个性并支持心理复原力,以改善外科医生的健康和福祉。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae072
Tasha M Hughes, Carrie E Cunningham
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引用次数: 0
Evolution and improved outcomes in the era of multimodality treatment for extended pancreatectomy. 扩展胰腺切除术多模式治疗时代的演变和更好的疗效。
IF 3.5 3区 医学 Q1 SURGERY 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

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.

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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引用次数: 0
Prospective nationwide analysis of long-term recurrence rates after elective ventral, incisional and parastomal hernia repairs. 对选择性腹股沟疝、切口疝和腹膜旁疝修补术后长期复发率的全国性前瞻性分析。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae070
Nadia A Henriksen, Frederik Helgstrand
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引用次数: 0
Total mesorectal excision quality in rectal cancer surgery affects local recurrence rate but not distant recurrence and survival: population-based cohort study. 直肠癌手术的全直肠系膜切除质量影响局部复发率,但不影响远处复发和生存:基于人群的队列研究。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae071
Åsa Collin, Cecilia Dahlbäck, Joakim Folkesson, Pamela Buchwald

Background: The quality of the total mesorectal excision specimen in rectal cancer surgery is assessed with a three-tier grade (mesorectal, intramesorectal and muscularis propria). This study aimed to analyse the prognostic impact of the total mesorectal excision grade on survival, and to identify risk factors for intramesorectal and muscularis propria resection in a population-based setting.

Methods: All patients in the Swedish Colorectal Cancer Registry with rectal cancer stage I-III ≤ 10 cm from the anal verge, diagnosed 2015-2019, undergoing total mesorectal excision were analysed. Clinical, surgical and pathological data were retrieved and analysed for the following primary outcomes: local and distant recurrence and overall and relative survival; secondary outcomes were risk factors for total mesorectal excision grading (intramesorectal or muscularis propria resection). Of note, postoperative death < 30 days or recurrence within 90 days were exclusion criteria for survival and recurrence analysis. Recurrence-free patients with less than 3 years follow-up, and patients lacking data regarding recurrence, were also excluded from recurrence analyses.

Results: Overall, of 7979 patients treated during the study interval, 1499 patients were eligible for recurrence, 2441 patients for survival and 2476 patients for risk-factor analyses, of which 75% were graded mesorectal, 17% intramesorectal and 8% muscularis propria. Median follow-up for survival was 42 (1-77) months. The worst total mesorectal excision grading (muscularis propria resection) was an independent risk factor for local recurrence in multivariable analysis (HR 2.73, 95% c.i. 1.07 to 7.0, P = 0.036). Total mesorectal excision grade had no impact on distant recurrence or survival. Female sex, tumour level <5 cm, abdominoperineal resection, minimally invasive surgery (laparoscopic and robotic), high blood loss, long duration of surgery and intraoperative perforation were independent risk factors for worse total mesorectal excision grading (intramesorectal and/or muscularis propria resection) in multivariable analyses.

Conclusion: Muscularis propria resection increases the risk of local recurrence but does not seem to affect distant recurrence or survival.

背景:直肠癌手术中全直肠间膜切除标本的质量由三级(直肠间膜、直肠内膜和固有肌)评估。本研究旨在分析总直肠间质切除等级对生存率的预后影响,并在基于人群的环境中确定直肠内和固有肌切除的风险因素:方法:分析瑞典结直肠癌登记处2015-2019年确诊的所有直肠癌I-III期(距肛缘≤10厘米)患者,这些患者均接受了全直肠系膜切除术。对临床、手术和病理数据进行了检索,并对以下主要结果进行了分析:局部和远处复发、总生存率和相对生存率;次要结果是全直肠系膜切除术分级(直肠内切除或肌固有层切除)的风险因素。值得注意的是,术后死亡<30天或90天内复发是生存率和复发分析的排除标准。复发分析还排除了随访不足 3 年的无复发患者和缺乏复发数据的患者:总体而言,在研究期间接受治疗的 7979 例患者中,有 1499 例患者符合复发分析条件,2441 例患者符合生存分析条件,2476 例患者符合风险因素分析条件,其中 75% 为直肠中膜分级,17% 为直肠内分级,8% 为固有肌分级。中位随访生存期为 42(1-77)个月。在多变量分析中,最差的总直肠系膜切除分级(肌固有层切除)是局部复发的独立风险因素(HR 2.73,95% c.i.1.07-7.0,P = 0.036)。全直肠系膜切除等级对远处复发或生存率没有影响。女性性别、肿瘤级别 结论:肌层切除会增加局部复发的风险,但似乎不会影响远处复发或生存。
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引用次数: 0
Robot-assisted minimally invasive oesophagectomy versus thoracoscopic approach: multi-institutional study on short-term outcomes. 机器人辅助微创食管切除术与胸腔镜方法:多机构短期疗效研究。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae063
Yin-Kai Chao, Jui-Ying Lee, Wen-Chien Huang, Jang-Ming Lee, Yau-Lin Tseng, Hung-I Lu

Background: Robot-assisted minimally invasive oesophagectomy and conventional minimally invasive oesophagectomy are superior to open techniques. However, few studies have directly compared the outcomes of the two minimally invasive approaches.

Methods: A retrospective study of patients from six medical centres with oesophageal squamous cell carcinoma who underwent minimally invasive oesophagectomy between 2015 and 2022. Perioperative outcomes were compared after applying inverse probability of treatment weighting.

Results: The study included 577 patients (robot-assisted minimally invasive oesophagectomy: 206; conventional minimally invasive oesophagectomy: 371). After applying inverse probability of treatment weighting, robot-assisted minimally invasive oesophagectomy was found to yield a higher number of mediastinal nodes compared with conventional minimally invasive oesophagectomy (14.86 versus 12.66, P = 0.017). Robot-assisted minimally invasive oesophagectomy was notably effective in retrieving upper mediastinal left recurrent laryngeal nerve nodes, averaging 1.97 nodes versus 1.14 nodes harvested by conventional minimally invasive oesophagectomy (P < 0.001). This was coupled by a significant decrease in nerve palsy rates (13.9% versus 22.8%, P = 0.020). A significantly larger percentage of patients in the robot-assisted minimally invasive oesophagectomy group had an uncomplicated postoperative course (51.8% versus 34%, P < 0.001). Robot-assisted minimally invasive oesophagectomy also led to a reduction in pneumonia rates (8.6% versus 15.2%, P = 0.041) and was linked to a shorter length of stay (length of stay; 16.64 versus 21.14 days, P = 0.007). The advantage of robot-assisted minimally invasive oesophagectomy in reducing the length of stay was especially pronounced in patients with a high Charlson co-morbidity index (≥2, mean difference 8.46 days; P = 0.0069) and those who underwent neoadjuvant therapy (mean difference 5.63 days; P < 0.001).

Conclusion: In oesophageal squamous cell carcinoma, the use of robot-assisted minimally invasive oesophagectomy led to fewer cases of pneumonia and faster recovery compared with conventional minimally invasive oesophagectomy. Additionally, robot-assisted minimally invasive oesophagectomy significantly improved the feasibility and safety of performing lymph node dissection along the recurrent laryngeal nerve.

背景:机器人辅助微创食管切除术和传统微创食管切除术均优于开放式技术。然而,很少有研究直接比较两种微创方法的疗效:对2015年至2022年期间在六个医疗中心接受微创食管切除术的食管鳞状细胞癌患者进行回顾性研究。采用逆治疗概率加权法对围手术期结果进行了比较:研究共纳入577例患者(机器人辅助微创食管切除术:206例;传统微创食管切除术:371例)。在应用逆治疗概率加权法后发现,与传统微创食管切除术相比,机器人辅助微创食管切除术产生的纵隔结节数量更高(14.86 对 12.66,P = 0.017)。机器人辅助微创食管切除术在取回上纵隔左喉返神经结节方面效果显著,平均取回1.97个结节,而传统微创食管切除术取回1.14个结节(P < 0.001)。同时,神经麻痹率也显著下降(13.9% 对 22.8%,P = 0.020)。机器人辅助微创食管切除术组患者术后无并发症的比例明显更高(51.8% 对 34%,P < 0.001)。机器人辅助微创食管切除术还降低了肺炎发生率(8.6%对15.2%,P = 0.041),并缩短了住院时间(住院时间:16.64天对21.14天,P = 0.007)。机器人辅助微创食管切除术在缩短住院时间方面的优势在夏尔森共病指数较高的患者(≥2,平均相差8.46天;P = 0.0069)和接受新辅助治疗的患者(平均相差5.63天;P < 0.001)中尤为明显:在食管鳞状细胞癌中,与传统的微创食管切除术相比,使用机器人辅助微创食管切除术可减少肺炎病例的发生,并加快康复速度。此外,机器人辅助微创食管切除术大大提高了沿喉返神经进行淋巴结清扫的可行性和安全性。
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引用次数: 0
Critical appraisal of the adequacy of surgical indications for non-functioning pancreatic neuroendocrine tumours. 对无功能胰腺神经内分泌肿瘤手术适应症充分性的严格评估。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-07-02 DOI: 10.1093/bjsopen/zrae083
Stefano Partelli, Anna Battistella, Valentina Andreasi, Francesca Muffatti, Domenico Tamburrino, Nicolò Pecorelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi

Background: The lack of preoperative prognostic factors to accurately predict tumour aggressiveness in non-functioning pancreatic neuroendocrine tumours may result in inappropriate management decisions. This study aimed to critically evaluate the adequacy of surgical treatment in patients with resectable non-functioning pancreatic neuroendocrine tumours and investigate preoperative features of surgical appropriateness.

Methods: A retrospective study was conducted on patients who underwent curative surgery for non-functioning pancreatic neuroendocrine tumours at San Raffaele Hospital (2002-2022). The appropriateness of surgical treatment was categorized as appropriate, potential overtreatment and potential undertreatment based on histologic features of aggressiveness and disease relapse within 1 year from surgery (early relapse).

Results: A total of 384 patients were included. Among them, 230 (60%) received appropriate surgical treatment, whereas the remaining 154 (40%) underwent potentially inadequate treatment: 129 (34%) experienced potential overtreatment and 25 (6%) received potential undertreatment. The appropriateness of surgical treatment was significantly associated with radiological tumour size (P < 0.001), tumour site (P = 0.012), surgical technique (P < 0.001) and year of surgical resection (P < 0.001). Surgery performed before 2015 (OR 2.580, 95% c.i. 1.570 to 4.242; P < 0.001), radiological tumour diameter < 25.5 mm (OR 6.566, 95% c.i. 4.010 to 10.751; P < 0.001) and pancreatic body/tail localization (OR 1.908, 95% c.i. 1.119 to 3.253; P = 0.018) were identified as independent predictors of potential overtreatment. Radiological tumour size was the only independent determinant of potential undertreatment (OR 0.291, 95% c.i. 0.107 to 0.791; P = 0.016). Patients subjected to potential undertreatment exhibited significantly poorer disease-free survival (P < 0.001), overall survival (P < 0.001) and disease-specific survival (P < 0.001).

Conclusions: Potential overtreatment occurs in nearly one-third of patients undergoing surgery for non-functioning pancreatic neuroendocrine tumours. Tumour diameter emerges as the sole variable capable of predicting the risk of both potential surgical overtreatment and undertreatment.

背景:缺乏术前预后因素来准确预测非功能性胰腺神经内分泌肿瘤的侵袭性,可能会导致不恰当的治疗决策。本研究旨在严格评估可切除的非功能性胰腺神经内分泌肿瘤患者手术治疗的适当性,并调查手术适当性的术前特征:对在圣拉斐尔医院(2002-2022年)接受非功能性胰腺神经内分泌肿瘤根治性手术的患者进行了一项回顾性研究。根据侵袭性组织学特征和手术后一年内疾病复发(早期复发)情况,将手术治疗的适当性分为适当治疗、潜在过度治疗和潜在治疗不足:结果:共纳入 384 例患者。结果:共纳入 384 例患者,其中 230 例(60%)接受了适当的手术治疗,其余 154 例(40%)接受了可能不适当的治疗:129人(34%)可能治疗过度,25人(6%)可能治疗不足。手术治疗的适当性与放射学肿瘤大小(P < 0.001)、肿瘤部位(P = 0.012)、手术技术(P < 0.001)和手术切除年份(P < 0.001)显著相关。2015年之前进行的手术(OR 2.580,95% 置信区间:1.570 至 4.242;P <0.001)、放射学肿瘤直径 < 25.5 mm(OR 6.566,95% 置信区间:4.010 至 10.751;P <0.001)和胰体/胰尾定位(OR 1.908,95% 置信区间:1.119 至 3.253;P = 0.018)被认为是潜在过度治疗的独立预测因素。放射学肿瘤大小是潜在治疗不足的唯一独立决定因素(OR 0.291,95% c.i. 0.107 至 0.791;P = 0.016)。潜在治疗不足患者的无病生存期(P < 0.001)、总生存期(P < 0.001)和疾病特异性生存期(P < 0.001)均明显较差:结论:近三分之一接受非功能性胰腺神经内分泌肿瘤手术的患者可能存在过度治疗。肿瘤直径是预测潜在手术过度治疗和治疗不足风险的唯一变量。
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