Background
Methods
Ethics
Patients
Surgical procedures
Evaluation of the pancreatic anatomical parameters
Definition of POPF
Statistical analysis
Results
Patient characteristics and postoperative pancreatic fistula
Open gastrectomy (n = 118) | Laparoscopic gastrectomy (n = 115) | p | |
---|---|---|---|
Age (years) median (range) | 71 (39–90) | 67 (42–88) | < 0.001 |
Sex (male/female) | 76/42 | 81/34 | 0.326 |
ASA-PS 1/2/3 | 9/91/18 | 8/99/8 | 0.122 |
Comorbidity | |||
Diabetes mellitus | 18 (15.3%) | 16 (13.9%) | 0.641 |
Cardiovascular disease | 12 (10.2%) | 15 (13.0%) | 0.493 |
Respiratory disease | 18 (15.2%) | 9 (7.8%) | 0.077 |
Renal dysfunction | 3 (2.5%) | 1 (0.8%) | 0.322 |
Total | 51 (43.2%) | 41 (35.7%) | 0.237 |
Body mass index (kg/m2) | |||
Median (range) | 22.3 (17.2–34.7) | 23.2 (16.4–31.5) | 0.484 |
Tumor location | |||
Upper third (%) | 33 (28.0%) | 27 (23.5%) | |
Middle third (%) | 45 (38.1%) | 32 (27.8%) | 0.066 |
Lower third (%) | 40 (33.9%) | 56 (48.7%) | |
cStage | |||
I/II/III/IV | 28/35/51/4 | 115/0/0/0 | < 0.001 |
Surgical procedure | |||
DG (%) | 60 (50.8%) | 77 (67.0%) | |
PPG (%) | 0 (0%) | 3 (2.6%) | |
PG (%) | 20 (16.9%) | 25 (21.7%) | < 0.001 |
TG (%) | 38 (32.1%) | 10 (8.7%) | |
Lymphadenectomy | |||
D1+/D2 | 38/80 | 112/3 | < 0.001 |
Operative duration (min) | |||
Median (range) | 224 (97–433) | 277 (159–432) | < 0.001 |
Blood loss (g) | |||
Median (range) | 200 (0–1370) | 5 (5–380) | < 0.001 |
Perioperative transfusion | |||
Yes/No | 12/106 | 1/114 | 0.002 |
D-Amy (IU/L) | |||
POD1 Median (range) | 320 (43–16,764) | 419 (38–12,154) | 0.234 |
POD3 Median (range) | 123 (12–2855) | 134 (24–5670) | 0.016 |
POPF | |||
Total | 27 (22.9%) | 31 (27.0%) | |
BL | 16 (13.6%) | 24 (20.9%) | |
Grade B | 10 (8.5%) | 7 (6.1%) | 0.239 |
Grade C | 1 (0.8%) | 0 (0%) | |
PLH (mm) median (range) | 8.3 (−26.7–34.9) | 10.1 (−19.8–24.9) | 0.615 |
PLD (mm) median (range) | 11.4 (−5–25.8) | 11.2 (0–27.1) | 0.842 |
P-A length (mm) median (range) | 35.5 (12.3–59.8) | 35.8 (16.7–49.8) | 0.716 |
Anatomical parameter characteristics of the pancreas and POPF
Risk factors for POPF
Open gastrectomy (n = 118) | Laparoscopic gastrectomy (n = 115) | ||||||
---|---|---|---|---|---|---|---|
Variables | OR | 95%CI | p | Variables | OR | 95%CI | p |
Age (years) | Age (year) | ||||||
≥75 | 1.48 | 0.59–3.74 | 0.402 | ≥75 | 1 | 0.90–10.7 | 0.073 |
< 75 | 1 | < 75 | 3.11 | ||||
Sex | Sex | ||||||
Male | 1.33 | 0.50–3.55 | 0.565 | Male | 1.22 | 0.48–3.08 | 0.677 |
Female | 1 | Female | 1 | ||||
BMI (kg/m2) | BMI (kg/m2) | ||||||
≥25 | 1.40 | 0.51–3.81 | 0.510 | ≥25 | 2.49 | 1.00–6.19 | 0.051 |
< 25 | 1 | < 25 | 1 | ||||
ASA-PS | ASA-PS | ||||||
2,3 | 2.29 | 0.64–8.15 | 0.203 | 2,3 | 1.09 | 0.20–5.93 | 0.921 |
1 | 1 | 1 | 1 | ||||
Comorbidity | Comorbidity | ||||||
Absent | 1 | 0.51–2.94 | 0.653 | Absent | 1 | 0.54–2.96 | 0.591 |
Present | 1.22 | Present | 1.26 | ||||
cStage | cStage | ||||||
I, II | 1 | 0.73–4.38 | 0.201 | I, II | N.E. | N.E. | N.E. |
III, IV | 1.79 | III, IV | |||||
Procedure | Procedure | ||||||
TG | 1.14 | 0.48–2.73 | 0.767 | TG | 2.00 | 0.38–10.6 | 0.415 |
DG/PPG/PG | 1 | DG/PPG/PG | 1 | ||||
Operative duration (min) | Operative duration (min) | ||||||
≥224 | 2.29 | 0.92–5.71 | 0.074 | ≥277 | 1.91 | 0.81–4.51 | 0.140 |
< 224 | 1 | < 277 | 1 | ||||
Blood loss (g) | Blood loss (g) | ||||||
≥200 | 2.55 | 1.05–6.18 | 0.038 | ≥5 | 1.38 | 0.60–3.18 | 0.442 |
< 200 | 1 | < 5 | 1 | ||||
D-number | D-number | ||||||
D2 | 1.19 | 0.47–3.02 | 0.719 | D2 | 2.25 | 0.23–22.1 | 0.486 |
D1+ | 1 | D1+ | 1 | ||||
PLH (mm) | PLH (mm) | ||||||
≥12.4 | 1.63 | 0.68–3.87 | 0.266 | ≥12.4 | 3.93 | 1.61–9.57 | 0.003 |
< 12.4 | 1 | < 12.4 | 1 | ||||
P-A length (mm) | P-A length (mm) | ||||||
≥45 | 1.01 | 0.25–3.96 | 0.995 | ≥45 | 3.59 | 1.16–11.0 | 0.026 |
< 45 | 1 | < 45 | 1 |
Open gastrectomy (n = 118) | Laparoscopic gastrectomy (n = 115) | ||||||
---|---|---|---|---|---|---|---|
Variables | OR | 95%CI | p | Variables | OR | 95%CI | p |
Operative duration (min) | Age (year) | ||||||
≥224 | 1.92 | 0.75–4.92 | 0.171 | ≥75 | 0.23 | 0.04–1.19 | 0.080 |
< 224 | 1 | < 75 | 1 | ||||
Blood loss (g) | BMI (kg/m2) | ||||||
≥200 | 2.70 | 1.04–7.01 | 0.041 | ≥25 | 2.07 | 0.76–5.08 | 0.153 |
< 200 | 1 | < 25 | 1 | ||||
PLH (mm) | |||||||
≥12.4 | 4.19 | 1.57–11.3 | 0.004 | ||||
< 12.4 | 1 | ||||||
P-A length (mm) ≥45 < 45 | 4.061 | 1.05–15.7 | 0.042 |
The association between drain amylase level and the PLH and P-A length
P-A length ≥ 45 n = 14 | P-A length < 45 n = 101 | p | ||
---|---|---|---|---|
Laparoscopic Gastrectomy | D-Amy (IU/L) POD 1 | 596.0 (40–10,484) | 419.0 (38–12,154) | 0.300 |
D-Amy (IU/L) POD 3 | 323.0 (31–2552) | 134.0 (24–5670) | 0.044 | |
P-A length ≥ 45 n = 18 | P-A length ≥ 45 n = 100 | p | ||
Open Gastrectomy | D-Amy (IU/L) POD 1 | 237.0 (57–14,848) | 369.0 (43–16,764) | 0.585 |
D-Amy (IU/L) POD 3 | 82.5 (41–1056) | 65.0 (12–2855) | 0.284 | |
PLH ≥ 12.4 n = 47 | PLH < 12.4 n = 68 | p | ||
Laparoscopic Gastrectomy | D-Amy (IU/L) POD 1 | 657.5 (38–12,154) | 319.0 (40–3867) | 0.002 |
D-Amy (IU/L) POD 3 | 182.5 (40–5670) | 129.0 (24–890) | 0.004 | |
PLH ≥ 12.4 n = 44 | PLH < 12.4 n = 74 | p | ||
Open Gastrectomy | D-Amy (IU/L) POD 1 | 357.5 (43–14,848) | 313.5 (57–16,764) | 0.585 |
D-Amy (IU/L) POD 3 | 87.5 (19–2855) | 106.0 (12–1594) | 0.856 |