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The inflammatory response after laparoscopic and open pancreatoduodenectomy and the association with complications in a multicenter randomized controlled trial.
HPB ( IF 2.7 ) Pub Date : 2019-04-09 , DOI: 10.1016/j.hpb.2019.03.353 Jony van Hilst 1 , David J Brinkman 2 , Thijs de Rooij 1 , Susan van Dieren 3 , Michael F Gerhards 4 , Ignace H de Hingh 5 , Misha D Luyer 5 , Hendrik A Marsman 4 , Tom M Karsten 4 , Olivier R Busch 1 , Sebastiaan Festen 4 , Michal Heger 6 , Marc G Besselink 1 ,
HPB ( IF 2.7 ) Pub Date : 2019-04-09 , DOI: 10.1016/j.hpb.2019.03.353 Jony van Hilst 1 , David J Brinkman 2 , Thijs de Rooij 1 , Susan van Dieren 3 , Michael F Gerhards 4 , Ignace H de Hingh 5 , Misha D Luyer 5 , Hendrik A Marsman 4 , Tom M Karsten 4 , Olivier R Busch 1 , Sebastiaan Festen 4 , Michal Heger 6 , Marc G Besselink 1 ,
Affiliation
BACKGROUND
The systemic inflammatory response seen after surgery seems to be related to postoperative complications. A reduction of the inflammatory response through minimally invasive surgery might therefore be the mechanism via which postoperative outcome could be improved. The aim of this study was to investigate if postoperative inflammatory markers differed between laparoscopic (LPD) and open pancreatoduodenectomy (OPD) and if there was a relationship between inflammatory markers and the occurrence of postoperative complications.
METHODS
A side study of the multicenter randomized controlled LEOPARD-2 trial comparing LPD to OPD was performed. Area under the curve (AUC) for plasma inflammatory markers, including interleukin (IL-) 6, IL-8 and C reactive protein (CRP) levels, were determined during the first 96 postoperative hours and compared between LPD and OPD, Clavien-Dindo ≥ III complications, and postoperative pancreatic fistula (POPF) grade B/C.
RESULTS
Overall, 38 patients were included (18 LPD and 20 OPD). The median AUC of IL-6 was 627 (195-1378) after LPD vs. 338 (175-694)pg/mL after OPD, (p = 0.114). The AUC of IL-8 and CRP were comparable. IL-6 levels were higher in patients with a Clavien-Dindo ≥ III complication (634[309-1489] vs. 297 [171-680], p = 0.034) and POPF grade B/C (994 [534-3265] vs. 334 [173-704], p = 0.003). In patients with a POPF grade B/C, IL-6 levels tended to be higher after LPD, as compared to OPD (3533[IQR 1133-3533] vs. 715[IQR 39-1658], p = 0.053).
CONCLUSION
LPD, as compared to OPD, did not reduce the postoperative inflammatory response. IL-6 levels were associated with postoperative complications and pancreatic fistula.
中文翻译：
在一项多中心随机对照试验中，进行腹腔镜和开腹胰十二指肠切除术后的炎症反应以及并发症的相关性。
背景技术手术后出现的全身炎症反应似乎与术后并发症有关。因此，通过微创手术减少炎症反应可能是改善术后结果的机制。这项研究的目的是调查腹腔镜（LPD）和开腹胰十二指肠切除术（OPD）之间的术后炎症标志物是否存在差异，以及炎症标志物与术后并发症的发生之间是否存在关系。方法对LPD与OPD进行比较的多中心随机对照LEOPARD-2试验进行了辅助研究。血浆炎症标记物的曲线下面积（AUC），包括白介素（IL-）6，IL-8和C反应蛋白（CRP）水平，在术后的最初96个小时内进行了检查，并比较了LPD和OPD，Clavien-Dindo≥III并发症和术后胰瘘（POPF）B / C级。结果总体上，共纳入38例患者（18例LPD和20例OPD）。LPD后IL-6的中位AUC为627（195-1378），而OPD后为338（175-694）pg / mL（p = 0.114）。IL-8和CRP的AUC相当。Clavien-Dindo≥III并发症（634 [309-1489] vs. 297 [171-680]，p = 0.034）和POPF B / C级患者的IL-6水平较高（994 [534-3265] vs 334 [173-704]，p = 0.003）。与OPD相比，在POPF B / C级的患者中，LPD后的IL-6水平倾向于更高（3533 [IQR 1133-3533]对715 [IQR 39-1658]，p = 0.053）。结论与OPD相比，LPD不能减轻术后炎症反应。
更新日期：2019-04-09
中文翻译：
在一项多中心随机对照试验中，进行腹腔镜和开腹胰十二指肠切除术后的炎症反应以及并发症的相关性。
背景技术手术后出现的全身炎症反应似乎与术后并发症有关。因此，通过微创手术减少炎症反应可能是改善术后结果的机制。这项研究的目的是调查腹腔镜（LPD）和开腹胰十二指肠切除术（OPD）之间的术后炎症标志物是否存在差异，以及炎症标志物与术后并发症的发生之间是否存在关系。方法对LPD与OPD进行比较的多中心随机对照LEOPARD-2试验进行了辅助研究。血浆炎症标记物的曲线下面积（AUC），包括白介素（IL-）6，IL-8和C反应蛋白（CRP）水平，在术后的最初96个小时内进行了检查，并比较了LPD和OPD，Clavien-Dindo≥III并发症和术后胰瘘（POPF）B / C级。结果总体上，共纳入38例患者（18例LPD和20例OPD）。LPD后IL-6的中位AUC为627（195-1378），而OPD后为338（175-694）pg / mL（p = 0.114）。IL-8和CRP的AUC相当。Clavien-Dindo≥III并发症（634 [309-1489] vs. 297 [171-680]，p = 0.034）和POPF B / C级患者的IL-6水平较高（994 [534-3265] vs 334 [173-704]，p = 0.003）。与OPD相比，在POPF B / C级的患者中，LPD后的IL-6水平倾向于更高（3533 [IQR 1133-3533]对715 [IQR 39-1658]，p = 0.053）。结论与OPD相比，LPD不能减轻术后炎症反应。
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