协和医学杂志2024，Vol.15Issue(4)：807-818,12.DOI:10.12290/xhyxzz.2024-0163
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
摘要
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分类
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李天宇,赵邦博,李泽儒,赵宇彤,韩显林,张太平,戴梦华,郭俊超,王维斌..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[J].协和医学杂志,2024,15(4):807-818,12.基金项目
中央高水平医院临床科研专项(2022-PUMCH-B-004) National High Level Hospital Clinical Research Funding(2022-PUMCH-B-004) （2022-PUMCH-B-004）
