Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry.
Biliary bypass
Explorative surgery
Gastroenteric bypass
Palliative surgery
Pancreatic ductal adenocarcinoma
Registry analysis
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
11 Nov 2022
11 Nov 2022
Historique:
received:
29
05
2022
accepted:
31
10
2022
entrez:
11
11
2022
pubmed:
12
11
2022
medline:
16
11
2022
Statut:
epublish
Résumé
Non-resectability is common in patients with pancreatic ductal adenocarcinoma (PDAC) due to local invasion or distant metastases. Then, biliary or gastroenteric bypasses or both are often established despite associated morbidity and mortality. The current study explores outcomes after palliative bypass surgery in patients with non-resectable PDAC. From the prospectively maintained German StuDoQ|Pancreas registry, all patients with histopathologically confirmed PDAC who underwent non-resective pancreatic surgery between 2013 and 2018 were retrospectively identified, and the influence of the surgical procedure on morbidity and mortality was analyzed. Of 389 included patients, 127 (32.6%) underwent explorative surgery only, and a biliary, gastroenteric or double bypass was established in 92 (23.7%), 65 (16.7%) and 105 (27.0%). After exploration only, patients had a significantly shorter stay in the intensive care unit (mean 0.5 days [SD 1.7] vs. 1.9 [3.6], 2.0 [2.8] or 2.1 [2.8]; P < 0.0001) and in the hospital (median 7 days [IQR 4-11] vs. 12 [10-18], 12 [8-19] or 12 [9-17]; P < 0.0001), and complications occurred less frequently (22/127 [17.3%] vs. 37/92 [40.2%], 29/65 [44.6%] or 48/105 [45.7%]; P < 0.0001). In multivariable logistic regression, biliary stents were associated with less major (Clavien-Dindo grade ≥ IIIa) complications (OR 0.49 [95% CI 0.25-0.96], P = 0.037), whereas-compared to exploration only-biliary, gastroenteric, and double bypass were associated with more major complications (OR 3.58 [1.48-8.64], P = 0.005; 3.50 [1.39-8.81], P = 0.008; 4.96 [2.15-11.43], P < 0.001). In patients with non-resectable PDAC, biliary, gastroenteric or double bypass surgery is associated with relevant morbidity and mortality. Although surgical palliation is indicated if interventional alternatives are inapplicable, or life expectancy is high, less invasive options should be considered.
Sections du résumé
BACKGROUND
BACKGROUND
Non-resectability is common in patients with pancreatic ductal adenocarcinoma (PDAC) due to local invasion or distant metastases. Then, biliary or gastroenteric bypasses or both are often established despite associated morbidity and mortality. The current study explores outcomes after palliative bypass surgery in patients with non-resectable PDAC.
METHODS
METHODS
From the prospectively maintained German StuDoQ|Pancreas registry, all patients with histopathologically confirmed PDAC who underwent non-resective pancreatic surgery between 2013 and 2018 were retrospectively identified, and the influence of the surgical procedure on morbidity and mortality was analyzed.
RESULTS
RESULTS
Of 389 included patients, 127 (32.6%) underwent explorative surgery only, and a biliary, gastroenteric or double bypass was established in 92 (23.7%), 65 (16.7%) and 105 (27.0%). After exploration only, patients had a significantly shorter stay in the intensive care unit (mean 0.5 days [SD 1.7] vs. 1.9 [3.6], 2.0 [2.8] or 2.1 [2.8]; P < 0.0001) and in the hospital (median 7 days [IQR 4-11] vs. 12 [10-18], 12 [8-19] or 12 [9-17]; P < 0.0001), and complications occurred less frequently (22/127 [17.3%] vs. 37/92 [40.2%], 29/65 [44.6%] or 48/105 [45.7%]; P < 0.0001). In multivariable logistic regression, biliary stents were associated with less major (Clavien-Dindo grade ≥ IIIa) complications (OR 0.49 [95% CI 0.25-0.96], P = 0.037), whereas-compared to exploration only-biliary, gastroenteric, and double bypass were associated with more major complications (OR 3.58 [1.48-8.64], P = 0.005; 3.50 [1.39-8.81], P = 0.008; 4.96 [2.15-11.43], P < 0.001).
CONCLUSIONS
CONCLUSIONS
In patients with non-resectable PDAC, biliary, gastroenteric or double bypass surgery is associated with relevant morbidity and mortality. Although surgical palliation is indicated if interventional alternatives are inapplicable, or life expectancy is high, less invasive options should be considered.
Identifiants
pubmed: 36368993
doi: 10.1186/s12893-022-01833-3
pii: 10.1186/s12893-022-01833-3
pmc: PMC9652845
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
389Subventions
Organisme : Deutsche Forschungsgemeinschaft
ID : 401299842
Informations de copyright
© 2022. The Author(s).
Références
HPB (Oxford). 2012 Jul;14(7):469-75
pubmed: 22672549
Cochrane Database Syst Rev. 2013 Feb 28;(2):CD008533
pubmed: 23450583
HPB (Oxford). 2016 May;18(5):470-8
pubmed: 27154812
J Pain Symptom Manage. 2014 Feb;47(2):307-14
pubmed: 23830531
World J Surg Oncol. 2020 Apr 1;18(1):63
pubmed: 32238149
J Gastrointest Surg. 2011 Nov;15(11):1917-27
pubmed: 21913044
J Surg Oncol. 2014 Jun;109(7):697-701
pubmed: 24395080
J Gastrointest Surg. 2014 Jul;18(7):1292-8
pubmed: 24671470
Cancer Med. 2016 Sep;5(9):2649-56
pubmed: 27356493
Radiology. 2018 May;287(2):374-390
pubmed: 29668413
Cochrane Database Syst Rev. 2016 Jul 06;7:CD009323
pubmed: 27383694
Transl Gastroenterol Hepatol. 2019 May 07;4:28
pubmed: 31231695
J Gastrointest Surg. 2022 Feb;26(2):352-359
pubmed: 35064457
Visc Med. 2017 May;33(2):126-130
pubmed: 28560227
Ann Surg. 1999 Sep;230(3):322-8; discussion 328-30
pubmed: 10493479
J Natl Compr Canc Netw. 2017 Aug;15(8):1028-1061
pubmed: 28784865
Surg Today. 2021 May;51(5):686-694
pubmed: 32897517
HPB (Oxford). 2020 Apr;22(4):563-569
pubmed: 31537457
Surg Clin North Am. 2005 Apr;85(2):359-71
pubmed: 15833477
Gastrointest Endosc. 2022 Jan;95(1):90-91
pubmed: 34711403
World J Surg. 2019 Mar;43(3):937-943
pubmed: 30478680
CA Cancer J Clin. 2021 May;71(3):209-249
pubmed: 33538338
Ann Surg Oncol. 2018 Apr;25(4):1009-1016
pubmed: 29388123
Gastrointest Endosc. 2010 Mar;71(3):490-9
pubmed: 20003966
Cancer Res. 2014 Jun 1;74(11):2913-21
pubmed: 24840647
Ann Surg. 2003 Dec;238(6):894-902; discussion 902-5
pubmed: 14631226
Am J Gastroenterol. 2006 Apr;101(4):735-42
pubmed: 16635221
Ann Oncol. 2015 Sep;26 Suppl 5:v56-68
pubmed: 26314780
HPB (Oxford). 2016 Jan;18(1):107-12
pubmed: 26776858
Surg Endosc. 2010 Feb;24(2):290-7
pubmed: 19551436
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004200
pubmed: 16625598
J Am Coll Surg. 1999 Jun;188(6):649-55; discussion 655-7
pubmed: 10359358
Surgery. 2017 Apr;161(4):939-950
pubmed: 28043693
Br J Surg. 2017 Oct;104(11):1568-1577
pubmed: 28832964
Semin Oncol. 2015 Feb;42(1):163-76
pubmed: 25726060
Surgery. 2011 Oct;150(4):607-16
pubmed: 22000171
Pancreatology. 2019 Oct;19(7):985-993
pubmed: 31563328
Ann Surg. 2009 Aug;250(2):187-96
pubmed: 19638912
J Surg Oncol. 2022 Mar;125(4):642-645
pubmed: 35015302
Trials. 2017 Apr 5;18(1):163
pubmed: 28381291
HPB (Oxford). 2016 Jan;18(1):13-20
pubmed: 26776846
Lancet. 2004 Mar 27;363(9414):1049-57
pubmed: 15051286