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Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry

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 pa...

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Autores principales: Hofmann, Felix O., Miksch, Rainer C., Weniger, Maximilian, Keck, Tobias, Anthuber, Matthias, Witzigmann, Helmut, Nuessler, Natascha C., Reissfelder, Christoph, Köninger, Jörg, Ghadimi, Michael, Bartsch, Detlef K., Hartwig, Werner, Angele, Martin K., D’Haese, Jan G., Werner, Jens
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652845/
https://www.ncbi.nlm.nih.gov/pubmed/36368993
http://dx.doi.org/10.1186/s12893-022-01833-3
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author Hofmann, Felix O.
Miksch, Rainer C.
Weniger, Maximilian
Keck, Tobias
Anthuber, Matthias
Witzigmann, Helmut
Nuessler, Natascha C.
Reissfelder, Christoph
Köninger, Jörg
Ghadimi, Michael
Bartsch, Detlef K.
Hartwig, Werner
Angele, Martin K.
D’Haese, Jan G.
Werner, Jens
author_facet Hofmann, Felix O.
Miksch, Rainer C.
Weniger, Maximilian
Keck, Tobias
Anthuber, Matthias
Witzigmann, Helmut
Nuessler, Natascha C.
Reissfelder, Christoph
Köninger, Jörg
Ghadimi, Michael
Bartsch, Detlef K.
Hartwig, Werner
Angele, Martin K.
D’Haese, Jan G.
Werner, Jens
author_sort Hofmann, Felix O.
collection PubMed
description 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: 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: 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: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-022-01833-3.
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spelling pubmed-96528452022-11-15 Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry Hofmann, Felix O. Miksch, Rainer C. Weniger, Maximilian Keck, Tobias Anthuber, Matthias Witzigmann, Helmut Nuessler, Natascha C. Reissfelder, Christoph Köninger, Jörg Ghadimi, Michael Bartsch, Detlef K. Hartwig, Werner Angele, Martin K. D’Haese, Jan G. Werner, Jens BMC Surg Research 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: 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: 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: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-022-01833-3. BioMed Central 2022-11-11 /pmc/articles/PMC9652845/ /pubmed/36368993 http://dx.doi.org/10.1186/s12893-022-01833-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hofmann, Felix O.
Miksch, Rainer C.
Weniger, Maximilian
Keck, Tobias
Anthuber, Matthias
Witzigmann, Helmut
Nuessler, Natascha C.
Reissfelder, Christoph
Köninger, Jörg
Ghadimi, Michael
Bartsch, Detlef K.
Hartwig, Werner
Angele, Martin K.
D’Haese, Jan G.
Werner, Jens
Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
title Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
title_full Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
title_fullStr Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
title_full_unstemmed Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
title_short Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
title_sort outcomes and risks in palliative pancreatic surgery: an analysis of the german studoq|pancreas registry
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652845/
https://www.ncbi.nlm.nih.gov/pubmed/36368993
http://dx.doi.org/10.1186/s12893-022-01833-3
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