Universität zu Köln

Loos, Martin, Al-Saeedi, Mohammed, Hinz, Ulf, Mehrabi, Arianeb, Schneider, Martin, Berchtold, Christoph, Mueller-Stich, Beat P., Schmidt, Thomas, Kulu, Yakup, Hoffmann, Katrin, Strobel, Oliver, Hackert, Thilo and Buechler, Markus W. (2022). Categorization of Differing Types of Total Pancreatectomy. JAMA Surg., 157 (2). S. 120 - 129. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-6262

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Abstract

IMPORTANCE Comparability of morbidity and mortality rates after total pancreatectomy (TP) reported by different surgical centers is limited. Procedure-specific differences, such as the extent of resection, including additional vascular or multivisceral resections, are rarely acknowledged when postoperative outcomes are reported. OBJECTIVES To evaluate postoperative outcomes after TP and categorize different types of TP based on the extent, complexity, and technical aspects of each procedure. DESIGN, SETTING, AND PARTICIPANTS This single-center study included a retrospective cohort of 1451 patients who had undergone TP between October 1, 2001, and December 31, 2020. Each patient was assigned to 1 of the following 4 categories that reflect increasing levels of procedure-related difficulty: standard TP (type 1), TP with venous resection (type 2), TP with multivisceral resection (type 3), and TP with arterial resection (type 4). Postoperative outcomes among the groups were compared. MAIN OUTCOMES AND MEASURES Categorization of different types of TP based on the procedure-related difficulty and differing postoperative outcomes. RESULTS Of the 1451 patients who had undergone TP and were included in the analysis, 840 were men (57.9%); median age was 64.9 (IQR, 56.7 71.7) years. A total of 676 patients (46.6%) were assigned to type 1, 296 patients (20.4%) to type 2, 314 patients (21.6%) to type 3, and 165 patients (11.4%) to type 4 TP. A gradual increase in surgical morbidity was noted by TP type (type 1: 255 [37.7%], type 2: 137 [46.3%], type 3: 178 [56.7%], and type 4: 98 [59.4%]; P < .001), as was noted for median length of hospital stay (type 1: 14 [IQR, 10-19] days, type 2:16 [IQR, 12-23] days, type 3:17 [IQR, 13-29] days, and type 4:18 [IQR, 13-30] days; P < .001), and 90-day mortality (type 1: 23 [3.4%], type 2: 17 [5.7%1 type 3:29 [9.2%), and type 4:20 [12.1%]; P < .001). In the multivariable analysis, type 3 (TP with multivisceral resection) and type 4 (TP with arterial resection) were independently associated with an increased 90-day mortality rate. CONCLUSIONS AND RELEVANCE The findings of this study suggest there are significant differences in postoperative outcomes when the extent, complexity, and technical aspects of the procedure are considered. Classifying TP into 4 different categories may allow for better postoperative risk stratification as well as more accurate comparisons in future studies.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Loos, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Al-Saeedi, Mohammed UNSPECIFIED UNSPECIFIED UNSPECIFIED Hinz, Ulf UNSPECIFIED UNSPECIFIED UNSPECIFIED Mehrabi, Arianeb UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Berchtold, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller-Stich, Beat P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kulu, Yakup UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Katrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Strobel, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Hackert, Thilo UNSPECIFIED UNSPECIFIED UNSPECIFIED Buechler, Markus W. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-579323
DOI:	10.1001/jamasurg.2021.5834
Journal or Publication Title:	JAMA Surg.
Volume:	157
Number:	2
Page Range:	S. 120 - 129
Date:	2022
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	2168-6262
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTERNATIONAL STUDY-GROUP; EXTENDED PANCREATECTOMY; DUCTAL ADENOCARCINOMA; SURGERY; DEFINITION; MORTALITY; CONSENSUS; OUTCOMES; SURVIVAL Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57932