International Reference Values for Surgical Outcomes of Total Pancreatectomy

作者：Philip C. Müller, Caroline Berchtold, Christoph Kuemmerli, Eva Breuer, Zhihao Li, Alessia Vallorani, Carsten Palnæs Hansen, Cristiano Guidetti, Janina Eden, Brady A. Campbell, Pengfei Wu, Sara Nicole Cecchetto, Hallbera Gudmundsdottir, Michael L. Kendrick, Patrick Starlinger, Nicolò Pecorelli, Giovanni Guarneri, Waqas Farooqui, Christoph Tschuor, Stefan Kobbelgaard Burgdorf, Julia Mühlhäusser, Jörn‐Markus Gass, Brian K. P. Goh, Ye-Xin Koh, Artur Rebelo, Jörg Kleeff, Tomas Seip, Martín de Santibañes, Letizia Todeschini, Giovanni Marchegiani, Nadiya Belfil, Mickaël Lesurtel, Marcel Autran C. Machado, Ugo Boggi, Emanuele F. Kauffmann, Marie Cappelle, Bas Groot Koerkamp, Fabrizio Di Benedetto, Keith Roberts, Avinoam Nevler, Harish Lavu, Philipp Dutkowski, Felix Nickel, Thilo Hackert, Jing He, Massimo Falconi, Mark J. Truty, Adrian T. Billeter, Beat P. Müller‐Stich, Outcomes for Total Pancreatectomy Group, James Halle‐Smith, Valentina Valle, Pier Cristoforo Giulianotti, Fabio Giannone, Patrick Pessaux, Patricia Sánchez‐Velázquez, Prabin Thapa, Dhiresh Kumar Maharjan, Orlando Jorge Martins Torres, Matta Kuzman, Sanjay Pandanaboyana · 发表于：JAMA Surgery · 年份：2025 · DOI：10.1001/jamasurg.2025.4941 · 被引用次数：5 · 研究领域：Pancreatic and Hepatic Oncology Research、Cardiac, Anesthesia and Surgical Outcomes、Surgical Simulation and Training

Importance: Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile. Objective: To define reference values for TP based on a low-risk cohort treated at expert centers. Design, Setting, and Participants: This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities. Exposures: TP. Main Outcomes and Measures: Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy. Results: Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) ...