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Master Thesis

Quel est l’impact de la survenue des complications hémorragiques sur la morbidité et sur la survie après duodénopancréatectomie céphalique ? : une étude bicentrique sur 1005 patients opérés

Abstract : Introduction: Post pancreatectomy hemorrhage (PPH) is a serious complication that can occur after pancreatoduodenectomy (PD). With a mortality rate of up to 30%, the consequences can lead to severe complications, delaying hospital discharge and administration of adjuvant treatment in cancers. The aim of this bicentric study was to evaluate the medium- and long-term impact of PPH after PD on surgical and oncologic outcomes. Methods: Patients who underwent PD surgery for all indications between 01/01/2005 and 31/12/2017 were divided into two groups: PPH and non-PPH. A flexible parametric survival model was used to determine evolution of the risk of death over time. Results: There were 121 patients in PPH and 886 in non-PPH without difference on type of lesion. Mortality was higher in PPH (21.5% vs. 3.2%, p<0.0001). There were more serious complications in PPH (54.6% vs. 10.4%, p<0.0001). The median survival was 19.6 vs. 37.1 months (p=0.0001) in the PPH and non-PPH groups. Half of the PPH had ≥44,3% chance of surviving 12 months vs. ≥64,4% for non-PPH. Among pancreatic adenocarcinomas (PDAC), grade C PPH had less access to adjuvant therapy than non-PPH (ORa=0.08 [0.02-0.27] p<0.0001). Conclusion: PPH after PD increases mortality by a factor of 7 and severe post-operative complications by a factor of 5. The negative impact on overall survival is observed up to 2 years after PD. Among patients operated for PDAC and cholangiocarcinoma, PPH alters oncologic outcomes.
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Submitted on : Wednesday, March 10, 2021 - 3:00:08 PM
Last modification on : Wednesday, October 27, 2021 - 5:31:25 AM
Long-term archiving on: : Friday, June 11, 2021 - 6:57:57 PM

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  • HAL Id : dumas-03165228, version 1
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Alexandre Thobie. Quel est l’impact de la survenue des complications hémorragiques sur la morbidité et sur la survie après duodénopancréatectomie céphalique ? : une étude bicentrique sur 1005 patients opérés. Médecine humaine et pathologie. 2020. ⟨dumas-03165228⟩

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