Back to Search Start Over

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy: Postoperative Outcomes and Quality of Life Analysis.

Authors :
Marchegiani G
Perri G
Burelli A
Zoccatelli F
Andrianello S
Luchini C
Donadello K
Bassi C
Salvia R
Source :
Annals of surgery [Ann Surg] 2022 Dec 01; Vol. 276 (6), pp. e905-e913. Date of Electronic Publication: 2021 Mar 04.
Publication Year :
2022

Abstract

Objective: To evaluate TP as an alternative to PD in patients at high-risk for popf.<br />Background: Outcomes of high-risk PD (HR-PD) and TP have never been compared.<br />Methods: All patients who underwent PD or TP between July 2017 and December 2019 were identified. HR-PD was defined according to the alternative fistula risk score. Postoperative outcomes (primary endpoint), pancreatic insufficiency, and quality of life after 12 months of follow-up (QoL) were compared between HR-PD or planned PD intraoperatively converted to TP (C-TP).<br />Results: A total of 566 patients underwent PD and 136 underwent TP during the study period. One hundred one (18%) PD patients underwent HR-PD, whereas 86 (63%) TP patients underwent C-TP. Postoperatively, the patients in the C-TP group exhibited lower rates of postpancreatectomy hemorrhage (15% vs 28%), delayed gastric emptying (16% vs 34%), sepsis (10% vs 31%), and Clavien-Dindo ≥3 morbidity (19% vs 31%) and had shorter median lengths of hospital stay (10 vs 21 days) (all P < 0.05). The rate of POPF in the HR-PD group was 39%. Mortality was comparable between the 2 groups (3% vs 4%). Although general, cancer- and pancreas-specific QoL were comparable between the HR-PD and C-TP groups, endocrine and exocrine insufficiency occurred in all the C-TP patients, compared to only 13% and 63% of the HR-PD patients, respectively, and C-TP patients had worse diabetesspecific QoL.<br />Conclusions: C-TP may be considered rather than HR-PD only in few selected cases and after adequate counseling.<br />Competing Interests: The authors report no conflicts of interest.<br /> (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Details

Language :
English
ISSN :
1528-1140
Volume :
276
Issue :
6
Database :
MEDLINE
Journal :
Annals of surgery
Publication Type :
Academic Journal
Accession number :
33914471
Full Text :
https://doi.org/10.1097/SLA.0000000000004840