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Pancreatic surgery with or without drainage: propensity score-matched study
BJS (British Journal of Surgery) Pub Date : 2022-04-14 , DOI: 10.1093/bjs/znac123
Felix Nickel 1 , Franziska Lang 1 , Karl Friedrich Kowalewski 1 , Caelan Max Haney 1 , Marc Menrath 1 , Christoph Berchtold 1 , Katrin Hoffmann 1 , Martin Loos 1 , Arianeb Mehrabi 1 , Pascal Probst 1 , Thomas Schmidt 1 , Martin Schneider 1 , Markus K Diener 1 , Oliver Strobel 1 , Beat P Müller-Stich 1 , Thilo Hackert 1
Affiliation  

Abstract Background A recent RCT has shown that routine intraoperative drain placement after pancreatoduodenectomy (PD) is not necessary. The aim was to confirm this in real-world conditions. Methods A propensity score-matched (PSM) analysis of patients with and without drainage after PD or distal pancreatectomy (DP) at a high-volume centre was undertaken. Main outcomes were complications and duration of hospital stay. Multivariable regression analysis was used to assessed which factors led to intraoperative drainage after the standard was changed from drain to no drain. Results Of 377 patients who underwent PD, 266 were included in PSM analysis. No drain was associated with fewer major complications (42 (31.6 per cent) versus 62 (46.6 per cent); P = 0.017), shorter duration of hospital stay (mean(s.d.) 14.7(8.5) versus 19.6(14.9) days; P = 0.001), and required fewer interventional drain placements (8.4 versus 19.8 per cent; P = 0.013). In PSM analysis after DP (112 patients), no drainage was associated with fewer clinically relevant postoperative pancreatic fistulas (9 versus 18 per cent; P = 0.016), fewer overall complications (mean(s.d.) comprehensive complication index score 15.9(15.4) versus 24.8(20.4); P = 0.012), and a shorter hospital stay (9.3(7.0) versus 13.5(9.9) days; P = 0.011). Multivisceral resection (OR 2.80, 95 per cent c.i. 1.10 to 7.59; P = 0.034) and longer operating times (OR 1.56, 1.04 to 2.36; P = 0.034) influenced the choice to place a drain after PD. Greater blood loss was associated with drainage after DP (OR 1.14, 1.02 to 1.30; P = 0.031). Conclusion Standard pancreatic resections can be performed safely without drainage. Surgeons were more reluctant to omit drainage after complex pancreatic resections.

中文翻译:

有或没有引流的胰腺手术:倾向评分匹配研究

摘要 背景最近的一项随机对照试验表明,胰十二指肠切除术 (PD) 后无需常规术中放置引流管。目的是在现实条件下证实这一点。 方法对大容量中心的 PD 或远端胰腺切除术 (DP) 后有或没有引流的患者进行了倾向评分匹配 (PSM) 分析。主要结局是并发症和住院时间。标准由引流改为不引流后,采用多变量回归分析评估哪些因素导致术中引流。 结果在 377 名接受 PD 的患者中,266 名被纳入 PSM 分析。不引流与较少的主要并发症相关(42 例(31.6%)与 62 例(46.6%);P = 0.017)、较短的住院时间(平均值(标准差)14.7(8.5)与 19.6(14.9)天);P = 0.001),并且需要更少的介入引流术(8.4% vs 19.8%;P = 0.013)。在 DP 后的 PSM 分析中(112 名患者),不引流与较少的临床相关术后胰瘘相关(9% vs 18%;P = 0.016),总体并发症较少(平均(sd)综合并发症指数评分 15.9(15.4) vs 24.8(20.4);P = 0.012),住院时间较短(9.3(7.0)天与 13.5(9.9)天;P = 0.011)。多脏器切除(OR 2.80,95% CI 1.10 至 7.59;P = 0.034)和较长的手术时间(OR 1.56,1.04 至 2.36;P = 0.034)影响 PD 后放置引流管的选择。DP 后引流与失血量较多有关(OR 1.14、1.02 至 1.30;P = 0.031)。 结论标准胰腺切除术可以安全地进行,无需引流。外科医生更不愿意在复杂的胰腺切除术后省略引流。
更新日期:2022-04-14
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