全胰切除术与胰十二指肠切除术治疗胰腺癌的手术疗效和生活质量对比分析:基于倾向性评分匹配的回顾性队列研究
Surgical Efficacy and Quality of Life of Total Pancreatectomy versus Pancreatico-duodenectomy for Pancreatic Cancer:A Retrospective Cohort Study Based on Propensity Score Matching
李天宇 1赵邦博 2李泽儒 1赵宇彤 1韩显林 2张太平 2戴梦华 2郭俊超 2王维斌2
作者信息
- 1. 中国医学科学院北京协和医学院研究生院,北京 100005;中国医学科学院北京协和医院基本外科,北京 100730
- 2. 中国医学科学院北京协和医院基本外科,北京 100730
- 折叠
摘要
目的 探究全胰切除术(total pancreatectomy,TP)与胰十二指肠切除术(pancreaticoduodenectomy,PD)治疗胰腺癌患者的术后短期并发症与长期预后差异.方法 回顾性收集北京协和医院 2016 年 1 月至 2021 年12 月行TP(TP组)和 2019 年 1 月至 2021 年 12 月行PD(PD组)的胰腺癌患者临床资料.根据危险因素的不同,将PD组患者分为胰瘘高风险PD组和复发高风险PD组.采用倾向性评分法匹配后,比较TP组与胰瘘高风险PD组、复发高风险PD组术后短期手术疗效指标(术后并发症发生率、30d死亡率、住院时间等)、长期手术疗效指标(总生存期)及生活质量差异.结果 共入选符合纳入与排除标准的TP组患者32 例,PD组174 例(胰瘘高风险PD组99 例,复发高风险PD组15 例).(1)TP组与胰瘘高风险PD组:经倾向性评分匹配后,最终纳入TP组患者29 例、胰瘘高风险PD组患者 56 例.TP组无胰瘘发生,胰瘘高风险PD组胰瘘发生率为 19.64%(P=0.027),两组其他术后并发症发生率、Clavien-Dindo分级、住院时间、ICU 停留时间、30d 死亡率等短期手术疗效指标均无统计学差异(P均＞0.05).中位随访时间36 个月时,两组生命质量核心量表(quality of life questionnaire-core 30,QLQ-C30)评分均无显著差异(P均＞0.05).(2)TP组与复发高风险PD组:由于两组基线资料均无统计学差异(P均＞0.05),故TP组 32 例患者、复发高风险 PD组 15 例患者均纳入分析.TP 组无胰瘘发生,复发高风险 PD组胰瘘发生率为20.00%(P=0.028),两组其他术后并发症发生率、Clavien-Dindo分级、住院时间、ICU停留时间、30d死亡率等短期手术疗效指标亦无统计学差异(P均＞0.05).截至末次随访,与复发高风险PD组比较,TP组中位总生存期更长(37.68 个月比 15.24 个月,HR=2.551,95%CI:1.144～5.689,P=0.018);多因素Cox回归分析显示,复发高风险PD、术前合并梗阻性黄疸是胰腺癌患者长期预后不良的独立危险因素.结论 对于胰瘘高风险胰腺癌患者,TP可取得与PD相当的短期手术疗效和长期生活质量,且术后无胰瘘负担.对于复发高风险胰腺癌患者,TP可在保证手术安全性的基础上显著延长患者生存期.
Abstract
Objective To investigate the differences in postoperative short-term complications and long-term prognosis of pancreatic cancer(PC)patients after total pancreatectomy(TP)and pancreaticoduodenec-tomy(PD).Methods Clinical data of PC patients who underwent TP from January 2016 to December 2021(TP group)and PD from January 2019 to December 2021(PD group)at Peking Union Medical College Hos-pital were retrospectively collected.Patients in the PD group were divided into the pancreatic fistula(PF)high-risk PD group and the recurrence high-risk PD group according to risk factors.After propensity score matc-hing,the differences in postoperative short-term surgical efficacy indicators(postoperative complication rate,30 d mortality rate,length of hospital stay,etc.),long-term surgical efficacy indicators(overall survival),and quality of life were compared between the TP group and the PF high-risk PD group or the recurrence high-risk PD group.Results A total of 32 patients in the TP group and 114 patients in the PD group(99 patients in the PF high-risk PD group and 15 patients in the recurrence high-risk PD group)meeting the inclusion and exclusion criteria were enrolled.(1)TP group and PF high-risk PD group:after propensity score matching,29 patients in the TP group and 56 patients in the PF high-risk PD group were finally included.There was no PF in the TP group,and the rate of PF in the PF high-risk PD group was 19.64%(P=0.027).There were no statistical differences in short-term surgical efficacy indicators such as other postoperative complication rates,Clavien-Dindo grading,length of stay,ICU stay,and 30 d mortality between the two groups(all P＞0.05).At the median follow-up time of 36 months,there was no significant difference in the quality of life questionnaire-core 30(QLQ-C30)scores between the two groups(P＞0.05).(2)TP group and recurrent high-risk PD group:Since there were no statistically significant differences between the baseline data of the two groups(P＞0.05),32 patients in the TP group and 15 patients in the recurrent high-risk PD group were both included in the analysis.There was no PF in the TP group,and the rate of PF in the recur-rent high-risk PD group was 20.00%(P=0.028).The other postoperative complication rates,Clavien-Dindo grading,length of hospital stay,ICU stay,30 d mortality and other short-term surgical efficacy indica-tors were also not statistically different between the two groups(all P＞0.05).By the final follow-up,the median overall survival was longer in the TP group than the recurrent high-risk PD group(37.68 months vs.15.24 months,HR=2.551,95%CI:1.144-5.689,P=0.018).Multifactorial Cox regression showed that recurrent high-risk PD and preoperative obstructive jaundice were independent risk factors in the poor long-term prognosis of patients with PC.Conclusions For PC patients at high risk of PF,TP can achieve short-term surgical outcomes and long-term quality of life comparable to PD with no burden of postoperative pancreatic fistula.For patients with high-risk recurrence,TP can significantly prolong the survival of PC pa-tients while ensuring surgical safety.
关键词
胰腺癌/全胰切除术/胰十二指肠切除术/倾向性评分/术后并发症/生活质量Key words
pancreatic cancer/total pancreatectomy/pancreaticoduodenectomy/propensity score/postoperative complica-tions/quality of life引用本文复制引用
基金项目
中央高水平医院临床科研专项(2022-PUMCH-B-004)
出版年
2024
国家科技期刊平台
NSTL
万方数据