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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...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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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. |
format | Online Article Text |
id | pubmed-9652845 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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