胰腺癌患者的外科第二意见

Surgical Second Opinion for Pancreatic Cancer Patients

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS

影响因子:3.4

分区:医学2区 / 外科2区

发表日期:2025 Mar 01

作者: Patrick L Quinn, Melica Nikahd, Shah Saiyed, Addie Heifetz, Natalie M Bath, J Madison Hyer, Jordan M Cloyd, Shikha Jain, Aslam Ejaz

DOI: 10.1097/XCS.0000000000001213

摘要

由于胰腺手术的复杂性，诊断为胰腺导管腺癌（PDAC）的患者可能会寻求不止一位外科医生的意见。目前关于第二次手术意见对胰腺切除术可能性及围手术期结局的影响知之甚少。本研究旨在评估获得第二次手术意见对胰腺切除率的影响，并评估其对手术结果的影响。我们通过使用100%的Medicare住院和门诊标准分析文件，识别2013年至2020年间诊断为PDAC的患者。收集的数据包括咨询的外科医生数量和地理区域。比较仅接受一次咨询与接受多次咨询的患者的胰腺切除术率和围手术期结局。在116,072名PDAC患者中，10,640（9.2%）接受了胰腺切除术。其中，4,913（4.2%）患者获得了第二次外科意见，且在第二次咨询后，有1,906（17.9%）患者接受了胰腺切除术。接受第二次外科意见的患者更可能接受胰腺切除（调整比值比6.17；95% CI 5.78-6.59）。接受第二次意见并手术的患者其住院时间和并发症发生率与未寻求第二意见的患者相比无显著差异（均p > 0.05）。在接受胰腺切除的Medicare患者中，约每7人中就有1人获得了第二次外科意见。未来研究需探讨患者动机、转诊模式、疾病特征及治疗等因素如何共同影响PDAC患者的临床结局。

Abstract

Due to the complexity of pancreatic surgery, patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) may seek out the opinion of more than 1 surgeon. Little is known regarding how second surgical opinions impact the likelihood of pancreatectomy and perioperative outcomes. Our study aimed to determine the impact of obtaining second surgical opinions on pancreatectomy rates and to assess its impact on surgical outcomes.Patients who were diagnosed with PDAC between 2013 and 2020 were identified using 100% Medicare Inpatient and Outpatient Standard Analytic Files. Data collected included the number of surgeons consulted and geographic region. Receipt of pancreatectomy and perioperative outcomes were compared between patients who received only 1 and more than 1 surgical consultation.Of 116,072 patients diagnosed with PDAC, 10,640 (9.2%) underwent pancreatectomy. A total of 4,913 (4.2%) patients received a second surgical opinion, of whom 1,906 (17.9%) patients underwent pancreatectomy after the second opinion visit. Patients receiving a second surgical opinion were more likely to undergo pancreatectomy (adjusted odds ratio 6.17; 95% CI 5.78 to 6.59). Patients who received a second opinion and underwent surgery had equivalent length of stay and complication rates compared to those who underwent surgery without seeking a second opinion (both p > 0.05).Among Medicare patients who underwent pancreatectomy for pancreatic cancer, approximately 1 in 7 patients received a second surgical opinion. Further research is needed to determine how patient motivations, referral patterns, disease characteristics, and treatments all interplay to affect clinical outcomes for patients undergoing pancreatectomy for PDAC.