Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study
Por:
Uijterwijk, BA, Lemmers, DH, Fusai, GK, Koerkamp, BG, Koek, S, Zerbi, A, Sparrelid, E, Boggi, U, Luyer, M, Ielpo, B, Salvia, R, Goh, BKP, Kazemier, G, Björnsson, B, Serradilla-Martín, M, Mazzola, M, Mavroeidis, VK, Sánchez-Cabús, S, Pessaux, P, White, S, Alseidi, A, Valle, RD, Korkolis, D, Bolm, LR, Soonawalla, Z, Roberts, KJ, Vladimirov, M, Mazzotta, A, Kleeff, J, Muñoz, MAS, Besselink, MG, Hilal, MA
Publicada:
1 mar 2024
Resumen:
Simple Summary: For cancer in the periampullary region, surgical resection with pancreatoduodenectomy remains the main curative treatment. Variations in prognosis suggest distinct growth patterns and tissue reactions, potentially influencing complications and perioperative mortality. This study aims to explore the impact of the type of periampullary adenocarcinoma on the perioperative hospital course. This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major morbidity (Clavien-Dindo 3b >=), clinically relevant post-operative pancreatic fistula (CR-POPF), and length of hospital stay (LOS). Results: Overall, 3622 patients were included in the study (370 DAC, 811 AmpIT, 895 AmpPB, 1083 dCCA, and 463 PDAC). Mortality rates were comparable between DAC, AmpIT, AmpPB, and dCCA (ranging from 3.7% to 5.9%), while lower for PDAC (1.5%, p = 0.013). Major morbidity rate was the lowest in PDAC (4.4%) and the highest for DAC (19.9%, p < 0.001). The highest rates of CR-POPF were observed in DAC (27.3%), AmpIT (25.5%), and dCCA (27.6%), which were significantly higher compared to AmpPB (18.5%, p = 0.001) and PDAC (8.3%, p < 0.001). The shortest LOS was found in PDAC (11 d vs. 14-15 d, p < 0.001). Discussion: In conclusion, this study shows significant variations in perioperative mortality, post-operative complications, and hospital stay among different periampullary cancers, and between the ampullary subtypes. Further research should assess the biological characteristics and tissue reactions associated with each type of periampullary cancer, including subtypes, in order to improve patient management and personalized treatment.
Filiaciones:
Uijterwijk, BA:
Fdn Poliambulanza, Dept Surg, I-25124 Brescia, Italy
Univ Amsterdam, Amsterdam UMC, Dept Surg, NL-1012 Amsterdam, Netherlands
Canc Ctr Amsterdam, NL-1081 Amsterdam, Netherlands
Lemmers, DH:
Fdn Poliambulanza, Dept Surg, I-25124 Brescia, Italy
Univ Amsterdam, Amsterdam UMC, Dept Surg, NL-1012 Amsterdam, Netherlands
Canc Ctr Amsterdam, NL-1081 Amsterdam, Netherlands
Fusai, GK:
Royal Free London NHS Fdn Trust, Dept Vasc Surg, London NW3 2QG, England
Koerkamp, BG:
Erasmus MC, NL-3015 Rotterdam, Netherlands
Koek, S:
Fiona Stanley Hosp, Dept Vasc Surg, Murdoch, WA 6150, Australia
Zerbi, A:
IRCCS Humanitas Res Hosp, Dept Pancreat Surg, I-20089 Rozzano, Italy
Sparrelid, E:
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, SE-17164 Huddinge, Sweden
Boggi, U:
Univ Pisa, Dept Surg, I-56100 Pisa, Italy
Luyer, M:
Catharina Hosp, Dept Surg, NL-5623 Eindhoven, Netherlands
Ielpo, B:
Hosp Mar, Dept Surg, Barcelona 08003, Spain
Salvia, R:
Univ Hosp Verona, Dept Surg, I-37126 Verona, Italy
Goh, BKP:
Singapore Gen Hosp, Natl Canc Ctr, Dept Hepatopancreatobilliary & Transplant Surg, Singapore 168583, Singapore
Duke Natl Univ, Singapore Med Sch, Surg Acad Clin Programme, Singapore 169857, Singapore
Kazemier, G:
Dept Surg, Amsterdam UMC, Locat VUmc, NL-1007 Amsterdam, Netherlands
Björnsson, B:
Linkoping Univ, Dept Surg Linkoping, Dept Biomed & Clin Sci, S-58183 Linkoping, Sweden
Serradilla-Martín, M:
Miguel Servet Univ Hosp, Dept Surg, Zaragoza 50009, Spain
Mazzola, M:
ASST Grande Osped Metropolitano Niguarda, Div Oncol & Mini invas Gen Surg, I-20162 Milan, Italy
Mavroeidis, VK:
Royal Marsden Hosp, Dept Acad Surg, London SW3 6JJ, England
Oxford Univ Hosp NHS Fdn Trust, Dept Hepatobiliary & Pancreat Surg, Oxford OX3 9DU, England
Sánchez-Cabús, S:
Hosp Santa Creu & Sant Pau, Dept Surg, Barcelona 08025, Spain
Pessaux, P:
Nouvel Hop Civil NHC, Hepatobiliary & Pancreat Surg Unit, F-67000 Strasbourg, France
White, S:
Newcastle Tyne Hosp, NHS Fdn Trust, Dept Surg, Newcastle Upon Tyne NE3 3HD, England
Alseidi, A:
Dept Surg, Virginia Mason, Seattle, WA 98101 USA
Valle, RD:
Univ Hosp Parma, Dept Surg, I-43126 Parma, Italy
Korkolis, D:
Hellen Anticanc Hosp St Savvas, Dept Surg, Athens 11522, Greece
Bolm, LR:
Univ Med Ctr Schleswig Holstein, Dept Surg, Campus Lubeck, D-23538 Lubeck, Germany
Soonawalla, Z:
Oxford Univ Hosp NHS Fdn Trust, Dept Hepatobiliary & Pancreat Surg, Oxford OX3 9DU, England
Roberts, KJ:
Univ Birmingham, Fac Med, Birmingham B15 2TT, England
Vladimirov, M:
Dept Surg Hosp Nuremberg, Dept Surg, Hosp Nuremberg, D-90419 Nurnberg, Germany
Mazzotta, A:
Inst Mutualiste Montsouris, Dept Digest Oncol & Metab Surg, F-75014 Paris, France
Kleeff, J:
Martin Luther Univ Halle Wittenberg, Dept Surg, D-06108 Halle, Saale, Germany
Muñoz, MAS:
Univ Hosp Virgen Victoria, Dept Surg, Malaga 29010, Spain
Besselink, MG:
Univ Amsterdam, Amsterdam UMC, Dept Surg, NL-1012 Amsterdam, Netherlands
Hilal, MA:
Fdn Poliambulanza, Dept Surg, I-25124 Brescia, Italy
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