胰腺癌患者的手术第二意见
Surgical Second Opinion for Pancreatic Cancer Patients
影响因子:3.40000
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
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1多名外科医生的意见。关于第二次手术意见如何影响胰腺切除术和围手术期结局的可能性，知之甚少。我们的研究旨在确定对胰腺切除术率获得第二种手术意见的影响，并评估其对手术结果的影响。使用100％Medicare住院和门诊标准分析文件确定了在2013年至2020年之间被诊断为PDAC的患者。收集的数据包括咨询的外科医生和地理区域的数量。比较了仅接受1次和1个以上手术咨询的患者的胰腺切除术和围手术期结局。116,072例被诊断为PDAC的患者，10,640（9.2％）接受了胰腺切除术。共有4,913例（4.2％）患者接受了第二次手术意见，其中1,906例（17.9％）患者在第二次意见访问后接受了胰腺切除术。接受第二次手术意见的患者更有可能进行胰腺切除术（调整后的比值比6.17； 95％CI 5.78至6.59）。与接受手术的患者相比，接受第二意见和接受手术的患者在不寻求第二意见的情况下的住院时间和并发症率相当（均为p> 0.05）。需要进一步的研究来确定患者动机，转诊模式，疾病特征和治疗方式如何影响PDAC接受胰腺切除术的患者的临床结果。
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.