Effects of operation sequence on early outcomes of pancreaticoduodenectomy
Objective To retrospectively analyze the effects of sequence of pancreaticoduodenectomy(Whipple surgery)on bleeding in operation and early outcomes.Methods The medical records of 519 pan-creatic cancer patients,305 males and 213 females,aged 32 to 86,BMI 15-35 kg/m2,ASA physical sta-tus Ⅰ-Ⅲ,who underwent Whipple surgery from 2017 to 2021 were collected.According to the sequence of operation,the patients were divided into two groups:group≤2 and group＞2.The primary outcome was hemorrhage during surgery.Secondary outcome was recorded including the crystalloid infusion volume,the colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infection,abdominal infection,gastric emp-tying disorders,fever,and length of postoperative hospital stay.Logistic regression was applied to examine the relations between the sequence of operation and hemorrhage during surgery.Results A total of 519 pa-tients was included in the study.415 patients(80.0％)belonged to the group≤2 and 104 patients be-longed to the group＞2.Compared with the group≤2,the incidence of major bleeding(RR=1.669,95％CI 1.146-2.430,P=0.011)in the group＞2 was higher significantly.There was no significant differ-ence in the crystalloid infusion volume,colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infec-tion,abdominal infection,gastric emptying disorders,fever,and length of postoperative hospital stay between the two groups.Logistic regression identified the sequence of operation＞2(OR=2.269,95％CI 1.318-3.907,P=0.003)and the longer surgery time(OR=1.012,95％CI 1.009-1.016,P＜0.001)as the risk factors for hemorrhage during operation.Conclusion The sequence of operation＞2 and the longer sur-gery time increase the risk of major bleeding in Whipple surgery for pancreatic cancer,while it has no signifi-cant impact on the length of postoperative hospital stay and postoperative complications in-hospital.
万方数据
维普
