PDF(Pubmed)
Abstract：
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) is a surgical procedure for treating pancreatic cancer; however, the risk of complications remains high owing to the wide range of organs involved during the surgery and the difficulty of anastomosis. Pancreatic fistula (PF) is a major complication that not only increases the risk of postoperative infection and abdominal hemorrhage but may also cause multi-organ failure, which is a serious threat to the patient\'s life. This study hypothesized the risk factors for PF after LPD.
OBJECTIVE: To identify the risk factors for PF after laparoscopic pancreatoduodenectomy in patients with pancreatic cancer.
METHODS: We retrospectively analyzed the data of 201 patients admitted to the Fudan University Shanghai Cancer Center between August 2022 and August 2023 who underwent LPD for pancreatic cancer. On the basis of the PF\'s incidence (grades B and C), patients were categorized into the PF (n = 15) and non-PF groups (n = 186). Differences in general data, preoperative laboratory indicators, and surgery-related factors between the two groups were compared and analyzed using multifactorial logistic regression and receiver-operating characteristic (ROC) curve analyses.
RESULTS: The proportions of males, combined hypertension, soft pancreatic texture, and pancreatic duct diameter ≤ 3 mm; surgery time; body mass index (BMI); and amylase (Am) level in the drainage fluid on the first postoperative day (Am > 1069 U/L) were greater in the PF group than in the non-PF group (P < 0.05), whereas the preoperative monocyte count in the PF group was lower than that in the non-PF group (all P < 0.05). The logistic regression analysis revealed that BMI > 24.91 kg/m² [odds ratio (OR) =13.978, 95% confidence interval (CI): 1.886-103.581], hypertension (OR = 8.484, 95%CI: 1.22-58.994), soft pancreatic texture (OR = 42.015, 95%CI: 5.698-309.782), and operation time > 414 min (OR = 15.41, 95%CI: 1.63-145.674) were risk factors for the development of PF after LPD for pancreatic cancer (all P < 0.05). The areas under the ROC curve for BMI, hypertension, soft pancreatic texture, and time prediction of PF surgery were 0.655, 0.661, 0.873, and 0.758, respectively.
CONCLUSIONS: BMI (> 24.91 kg/m²), hypertension, soft pancreatic texture, and operation time (> 414 min) are considered to be the risk factors for postoperative PF.
OBJECTIVE: To identify the risk factors for PF after laparoscopic pancreatoduodenectomy in patients with pancreatic cancer.
METHODS: We retrospectively analyzed the data of 201 patients admitted to the Fudan University Shanghai Cancer Center between August 2022 and August 2023 who underwent LPD for pancreatic cancer. On the basis of the PF\'s incidence (grades B and C), patients were categorized into the PF (n = 15) and non-PF groups (n = 186). Differences in general data, preoperative laboratory indicators, and surgery-related factors between the two groups were compared and analyzed using multifactorial logistic regression and receiver-operating characteristic (ROC) curve analyses.
RESULTS: The proportions of males, combined hypertension, soft pancreatic texture, and pancreatic duct diameter ≤ 3 mm; surgery time; body mass index (BMI); and amylase (Am) level in the drainage fluid on the first postoperative day (Am > 1069 U/L) were greater in the PF group than in the non-PF group (P < 0.05), whereas the preoperative monocyte count in the PF group was lower than that in the non-PF group (all P < 0.05). The logistic regression analysis revealed that BMI > 24.91 kg/m² [odds ratio (OR) =13.978, 95% confidence interval (CI): 1.886-103.581], hypertension (OR = 8.484, 95%CI: 1.22-58.994), soft pancreatic texture (OR = 42.015, 95%CI: 5.698-309.782), and operation time > 414 min (OR = 15.41, 95%CI: 1.63-145.674) were risk factors for the development of PF after LPD for pancreatic cancer (all P < 0.05). The areas under the ROC curve for BMI, hypertension, soft pancreatic texture, and time prediction of PF surgery were 0.655, 0.661, 0.873, and 0.758, respectively.
CONCLUSIONS: BMI (> 24.91 kg/m²), hypertension, soft pancreatic texture, and operation time (> 414 min) are considered to be the risk factors for postoperative PF.
摘要：
背景：腹腔镜胰十二指肠切除术（LPD）是一种治疗胰腺癌的外科手术；然而，由于手术过程中涉及的器官范围很广，吻合困难，并发症的风险仍然很高。胰瘘（PF）是一种主要并发症，不仅增加了术后感染和腹腔出血的风险，还可能导致多器官功能衰竭。这对病人的生命是一个严重的威胁。本研究假设了LPD后PF的危险因素。
目的：探讨胰腺癌患者腹腔镜胰十二指肠切除术后发生PF的危险因素。
方法：我们回顾性分析了2022年8月至2023年8月复旦大学上海癌症中心收治的201例胰腺癌患者的临床资料。根据PF的发病率(B级和C级)，患者分为PF组(n=15)和非PF组(n=186).一般数据的差异，术前实验室指标，采用多因素logistic回归和受试者-工作特征(ROC)曲线分析对两组患者的手术相关因素进行比较分析。
结果：男性的比例，合并高血压，软胰腺质地，和胰管直径≤3mm；手术时间；体重指数（BMI）；术后第一天引流液中淀粉酶（Am）水平（Am>1069U/L），PF组均高于非PF组（P<0.05），PF组术前单核细胞计数低于非PF组(均P<0.05)。logistic回归分析显示BMI>24.91kg/m²[比值比(OR)=13.978,95%置信区间(CI):1.886-103.581],高血压（OR=8.484，95CI：1.22-58.994），软胰腺质地（OR=42.015，95CI：5.698-309.782），手术时间>414min（OR=15.41，95CI：1.63-145.674）是胰腺癌LPD后PF发生的危险因素（均P<0.05）。BMI的ROC曲线下面积，高血压,软胰腺质地，PF手术时间预测分别为0.655、0.661、0.873和0.758。
结论：BMI（>24.91kg/m²），高血压,软胰腺质地，手术时间(>414min)被认为是术后PF的危险因素。
目的：探讨胰腺癌患者腹腔镜胰十二指肠切除术后发生PF的危险因素。
方法：我们回顾性分析了2022年8月至2023年8月复旦大学上海癌症中心收治的201例胰腺癌患者的临床资料。根据PF的发病率(B级和C级)，患者分为PF组(n=15)和非PF组(n=186).一般数据的差异，术前实验室指标，采用多因素logistic回归和受试者-工作特征(ROC)曲线分析对两组患者的手术相关因素进行比较分析。
结果：男性的比例，合并高血压，软胰腺质地，和胰管直径≤3mm；手术时间；体重指数（BMI）；术后第一天引流液中淀粉酶（Am）水平（Am>1069U/L），PF组均高于非PF组（P<0.05），PF组术前单核细胞计数低于非PF组(均P<0.05)。logistic回归分析显示BMI>24.91kg/m²[比值比(OR)=13.978,95%置信区间(CI):1.886-103.581],高血压（OR=8.484，95CI：1.22-58.994），软胰腺质地（OR=42.015，95CI：5.698-309.782），手术时间>414min（OR=15.41，95CI：1.63-145.674）是胰腺癌LPD后PF发生的危险因素（均P<0.05）。BMI的ROC曲线下面积，高血压,软胰腺质地，PF手术时间预测分别为0.655、0.661、0.873和0.758。
结论：BMI（>24.91kg/m²），高血压,软胰腺质地，手术时间(>414min)被认为是术后PF的危险因素。
