A propensity score analysis of over 12,000 pancreaticojejunal anastomoses after pancreaticoduodenectomy: does technique impact the clinically relevant fistula rate?,HPB

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A propensity score analysis of over 12,000 pancreaticojejunal anastomoses after pancreaticoduodenectomy: does technique impact the clinically relevant fistula rate?
HPB ( IF 2.7 ) Pub Date : 2020-02-01 , DOI: 10.1016/j.hpb.2020.01.002
Lyonell B Kone ₁ , Vijay K Maker ₁ , Mihaela Banulescu ₂ , Ajay V Maker ₁

Affiliation

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a major cause of morbidity in patients undergoing pancreatic surgery. Controversy exists as to whether there is any difference in CR-POPF with a Duct-to-Mucosa (DTM) versus an Invagination (IG) pancreaticojejunostomy (PJ).

Methods

Demographic, perioperative, intraoperative, and postoperative data were captured from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2014–2017 databases. Potential confounders were included in a logistic regression and a propensity score model. The primary outcome was CR-POPF.

Results

A total of 12,361 pancreaticojejunal anastomoses were performed with 11,168 patients undergoing DTM (90%) and 1193 undergoing IG (10%) after pancreaticoduodenectomy. Amongst all patients, there was no significant difference in CR-POPF between DTM and IG on multivariate (OR = 0.95, p = 0.64) or propensity score analysis (OR = 0.99, p = 0.93). After stratification by pancreatic gland texture and duct size, there was a decrease in CR-POPF with DTM amongst patients with duct size greater than 6 mm on multivariate analysis (OR = 0.35, p = 0.009) and propensity score analysis (OR = 0.40, p = 0.018). There were no significant differences in any other strata.

Conclusion

DTM or IG technique are not associated with CR-POPF for patients with average size pancreatic ducts; however, DTM is preferable in patients with large pancreatic duct diameter (>6 mm).

中文翻译：

对超过 12,000 例胰十二指肠切除术后胰空肠吻合的倾向评分分析：技术是否会影响临床相关的瘘管发生率？

背景

临床相关的术后胰瘘 (CR-POPF) 仍然是接受胰腺手术的患者发病的主要原因。关于 CR-POPF 与导管黏膜 (DTM) 与内陷 (IG) 胰空肠吻合术 (PJ) 是否存在差异存在争议。

方法

人口统计学、围手术期、术中和术后数据来自美国外科医师学会 (ACS) 国家外科质量改进计划 (NSQIP) 2014-2017 数据库。潜在的混杂因素包括在逻辑回归和倾向评分模型中。主要结果是 CR-POPF。

结果

胰十二指肠切除术后共进行了 12,361 例胰空肠吻合术，其中 11,168 例接受 DTM（90%）和 1193 例接受 IG（10%）。在所有患者中，多变量（OR = 0.95，p = 0.64）或倾向评分分析（OR = 0.99，p = 0.93）在 DTM 和 IG 之间的 CR-POPF 没有显着差异。在按胰腺质地和导管大小分层后，多变量分析（OR = 0.35，p = 0.009）和倾向评分分析（OR = 0.40， p = 0.018）。其他任何阶层均无显着差异。