International Reference Values for Surgical Outcomes of Total Pancreatectomy.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Müller Philip C, Berchtold Caroline, Kuemmerli Christoph, Breuer Eva, Li Zhihao, Vallorani Alessia, Hansen Carsten, Guidetti Cristiano, Eden Janina, Campbell Brady A, Wu Pengfei, Cecchetto Sara Nicole, Gudmundsdottir Hallbera, Kendrick Michael, Starlinger Patrick P, Pecorelli Nicolò, Guarneri Giovanni, Farooqui Waqas, Tschuor Christoph, Burgdorf Stefan Kobbelgaard, Mühlhäusser Julia, Gass Jörn-Markus, Goh Brian K P, Koh Ye-Xin, Rebelo Artur, Kleeff Jörg, Seip Tomas, Santibanes Martin, Todeschini Letizia, Marchegiani Giovanni, Belfil Nadiya, Lesurtel Mickaël, Machado Marcel, Boggi Ugo, Kauffmann Emanuele, Cappelle Marie, Koerkamp Bas Groot, Di Benedetto Fabrizio, Roberts Keith, Nevler Avinoam, Lavu Harish, Dutkowski Philipp, Nickel Felix, Hackert Thilo, He Jin, Falconi Massimo, Truty Mark, Billeter Adrian T, Müller Beat P, Outcomes for Total Pancreatectomy Group, Halle-Smith James, Valle Valentina, Giulianotti Pier, Giannone Fabio, Pessaux Patrick, Sánchez-Velázquez Patricia, Thapa Prabin Bikram, Maharjan Dhiresh, Torres Orlando, Kuzman Matta, Pandanaboyana Sanjay
Аннотация
OBJECTIVE: To define reference values for TP based on a low-risk cohort treated at expert centers.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities.
EXPOSURES: TP.
MAIN OUTCOMES AND MEASURES: Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy.
RESULTS: Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29).
CONCLUSIONS AND RELEVANCE: This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.