Introduction
Materials and methods
Patient collective
Data collection and variables
Statistical analysis
Ethics
Results
Patient characteristics and intraoperative parameters
PDAC (n = 518) | CAMP (n = 109) | p value | Mean standardized difference | |
---|---|---|---|---|
Demographic parameters and comorbidities | ||||
Age, years | 66.3 (11.1) | 66.5 (11.3) | 0.848 | 0.018 |
Sex | ||||
- male | 269 (51.9) | 59 (54.1) | 0.676 | 0.044 |
- female | 249 (48.1) | 50 (45.9) | ||
BMI, kg/m2 | 25.1 (4.5) | 25.0 (3.8) | 0.775 | 0.024 |
ASA classification | ||||
- ASA 1 | 22 (4.2) | 4 (3.7) | 0.783 | 0.040 |
- ASA 2 | 249 (48.1) | 57 (52.3) | 0.423 | 0.084 |
- ASA 3 | 234 (45.2) | 47 (43.1) | 0.695 | 0.042 |
- ASA 4 | 13 (2.5) | 1 (0.9) | 0.306 | 0.124 |
Comorbidities (n = 513) | 343 (79.0) | 65 (82.3) | 0.511 | 0.083 |
Coronary heart disease (n = 508) | 61 (14.2) | 11 (14.1) | 0.984 | 0.002 |
Hypertension (n = 510) | 235 (54.4) | 45 (57.7) | 0.590 | 0.066 |
Lung disease (n = 513) | 73 (16.8) | 17 (21.5) | 0.313 | 0.120 |
Renal disease (n = 513) | 43 (9.7) | 7 (8.4) | 0.712 | 0.045 |
Liver disease (n = 503) | 122 (28.6) | 18 (23.7) | 0.381 | 0.112 |
Diabetes mellitus | 125 (24.2) | 17 (15.7) | 0.057 | 0.214 |
Alcohol abuse | 47 (9.8) | 10 (10.0) | 0.939 | 0.007 |
Nicotin abuse | 97 (20.2) | 23 (23.0) | 0.524 | 0.068 |
Preoperative icterus | 343 (67.0) | 70 (65.4) | 0.754 | 0.034 |
Preoperative bile duct stent | 283 (55.3) | 68 (63.6) | 0.116 | 0.170 |
Neoadiuvant chemotherapy (n = 613) | 40 (7.7) | 0 (0.0) | 0.005 | 0.408 |
Adiuvant chemotherapy (n = 543) | 250 (55.2) | 23 (25.6) | <0.001 | 0.708 |
Surgical parameters | ||||
Duration of surgery, minutes | 432 (95.3) | 391 (86.4) | 0.001 | 0.455 |
Venous resection | 219 (42.3) | 8 (7.4) | < 0.001 | 0.883 |
Soft pancreas (n = 303) | 96 (38.1) | 36 (70.6) | < 0.001 | 0.395 |
Laparoscopical-assisted resection | 112 (21.6) | 33 (30.3) | 0.051 | 0.199 |
Reconstruction technique | ||||
- pancreatogastrostomy | 155 (29.9) | 53 (48.6) | < 0.001 | 0.390 |
- pancreaticojejunostomy | 363 (70.1) | 56 (51.4) | < 0.001 | 0.390 |
Diameter of pancreatic main duct, mm (n = 118) | 5.1 (2.2) | 3.8 (1.7) | 0.038 | 0.661 |
Histopathological results
PDAC (n = 518) | CAMP (n = 109) | p value | |
---|---|---|---|
Grading (n = 600) | |||
- G1 | 14 (2.8) | 8 (7.6) | 0.018 |
- G2 | 281 (56.8) | 61 (58.1) | 0.803 |
- G3 | 194 (39.2) | 36 (34.3) | 0.348 |
- G4 | 6 (1.2) | 0 (0.0) | 0.257 |
Resection margin (n = 626) | |||
- R0 | 392 (75.8) | 106 (97.2) | < 0.001 |
- R1 | 117 (22.6) | 3 (2.8) | < 0.001 |
- R2 | 8 (1.5) | 0 (0.0) | 0.191 |
TNM classification (n = 623) | |||
- T1 | 32 (6.2) | 15 (13.9) | 0.006 |
- T2 | 104 (20.2) | 37 (34.3) | 0.001 |
- T3 | 367 (71.3) | 43 (39.8) | < 0.001 |
- T4 | 12 (2.3) | 13 (12.0) | < 0.001 |
- N0 | 151 (29.3) | 51 (46.8) | < 0.001 |
- N1 | 315 (61.2) | 53 (48.6) | 0.016 |
- N2 | 49 (9.5) | 5 (4.6) | 0.096 |
Postoperative outcome: Complications and survival in patients with CAMP compared to PDAC patients in the unmatched and matched cohort
PDAC (n = 518) | CAMP (n = 109) | p value | |
---|---|---|---|
DGE B/C | 117 (22.8) | 28 (26.2) | 0.455 |
PPH B/C | 37 (8.6) | 6 (6.6) | 0.534 |
CR-POPF | 64 (12.4) | 33 (30.5) | < 0.001 |
Blood transfusion | 97 (18.8) | 12 (11.0) | 0.052 |
Wound infection | 67 (13.0) | 21 (19.6) | 0.071 |
Urinary tract infection | 33 (6.4) | 2 (1.9) | 0.063 |
Thrombembolism | 14 (2.7) | 3 (2.8) | 0.956 |
Intraabdominal abscess | 55 (10.6) | 13 (12.0) | 0.671 |
Pneumonia | 21 (4.1) | 3 (2.8) | 0.528 |
Reintubation | 22 (4.3) | 4 (3.7) | 0.808 |
Sepsis | 21 (4.1) | 2 (1.9) | 0.267 |
Acute kidney failure | 21 (4.1) | 0 (0.0) | 0.034 |
Insufficiency pancreaticojejunostomy | 21 (4.1) | 4 (3.7) | 0.849 |
Insufficiency pancreatogastrostomy | 12 (2.3) | 7 (6.4) | 0.023 |
Insufficiency biliodigestive anastomosis | 11 (2.1) | 1 (0.9) | 0.401 |
Postoperative mortality | 21 (4.1) | 4 (3.7) | 0.849 |
Any complication | 290 (56.1) | 70 (64.2) | 0.119 |
Surgery-related complication | 212 (40.9) | 62 (57.9) | 0.001 |
Surgical revision | 66 (12.8) | 13 (11.9) | 0.810 |
Postoperative interventional therapy (n = 624) | 132 (25.6) | 33 (30.6) | 0.286 |
Postoperative conservative therapy | 299 (58.6) | 76 (73.1) | 0.006 |
Hospital stay in days (median, range) | 17 (2 – 329) | 19 (6 – 377) | 0.012 |
Intensive Care Unit in days (median, range) | 5 (1 – 68) | 6 (2 – 52) | 0.562 |
Median overall survival, months (95% CI) | 21 (18.9 – 23.1) | 53 (19.2 -86.8) | <0.001 |
PDAC (n = 102) | CAMP (n = 102) | p value | Mean standardized difference | |
---|---|---|---|---|
Demographic parameters and comorbidities | ||||
Age, years | 64.5 (12.2) | 66.5 (11.2) | 0.200 | 0.170 |
Sex | ||||
- male | 53 (52.0) | 58 (56.9) | 0.482 | 0.098 |
- female | 49 (48.0) | 44 (43.1) | ||
BMI, kg/m2 | 25.5 (4.1) | 24.9 (3.7) | 0.292 | 0.154 |
ASA classification | ||||
- ASA 1 | 8 (7.8) | 4 (3.9) | 0.234 | 0.167 |
- ASA 2 | 54 (52.9) | 52 (51.0) | 0.779 | 0.038 |
- ASA 3 | 39 (38.2) | 45 (44.1) | 0.393 | 0.120 |
- ASA 4 | 1 (1.0) | 1 (1.0) | 1.000 | 0.000 |
Comorbidities (n = 157) | 64 (78.0) | 61 (81.3) | 0.610 | 0.082 |
Coronary heart disease (n = 153) | 10 (12.7) | 11 (14.9) | 0.692 | 0.063 |
Hypertension (n = 154) | 38 (47.5) | 42 (56.8) | 0.251 | 0.187 |
Lung disease (n = 155) | 17 (21.3) | 15 (20.0) | 0.848 | 0.027 |
Renal disease (n = 157) | 6 (7.6) | 6 (7.6) | 1.000 | 0.000 |
Liver disease (n = 150) | 23 (29.5) | 15 (20.8) | 0.223 | 0.201 |
Diabetes mellitus | 19 (18.8) | 16 (15.7) | 0.556 | 0.082 |
Alcohol abuse | 11 (12.2) | 10 (10.5) | 0.716 | 0.053 |
Nicotin abuse | 19 (21.1) | 23 (24.2) | 0.615 | 0.074 |
Preoperative icterus | 70 (70.0) | 66 (65.3) | 0.481 | 0.101 |
Preoperative bile duct stent | 59 (58.4) | 65 (64.4) | 0.386 | 0.123 |
Neoadiuvant chemotherapy (n = 191) | 9 (8.8) | 0 (0.0) | 0.004 | 0.439 |
Adiuvant chemotherapy (n = 168) | 48 (57.8) | 23 (27.1) | <0.001 | 0.762 |
Surgical parameters | ||||
Duration of surgery, minutes | 425 (97.6) | 393 (88.7) | 0.015 | 0.343 |
Venous resection | 8 (7.8) | 8 (7.8) | 1.000 | 0.000 |
Soft pancreas (n = 98) | 27 (55.1) | 34 (69.4) | 0.345 | 0.170 |
Laparoscopical-assisted resection | 31 (30.4) | 31 (30.4) | 1.000 | 0.000 |
Reconstruction technique | ||||
- pancreatogastrostomy | 48 (47.1) | 48 (47.1) | 1.000 | 0.000 |
- pancreaticojejunostomy | 54 (52.9) | 54 (52.9) | 1.000 | 0.000 |
Diameter of pancreatic main duct, mm (n = 35) | 5.2 (2.3) | 3.8 (1.7) | 0.077 | 0.692 |
PDAC (n = 102) | CAMP (n = 102) | p value | |
---|---|---|---|
Grading (n = 195) | |||
- G1 | 3 (3.1) | 6 (6.1) | 0.313 |
- G2 | 59 (60.8) | 59 (60.2) | 0.929 |
- G3 | 33 (34.0) | 33 (33.7) | 0.959 |
- G4 | 2 (2.1) | 0 (0.0) | 0.153 |
Resection margin | |||
- R0 | 84 (82.4) | 99 (97.1) | <0.001 |
- R1 | 15 (14.7) | 3 (2.9) | 0.003 |
- R2 | 3 (2.9) | 0 (0.0) | 0.081 |
TNM classification (n = 201) | |||
- T1 | 9 (9.0) | 12 (11.9) | 0.504 |
- T2 | 19 (19.0) | 36 (35.6) | 0.008 |
- T3 | 71 (71.0) | 40 (39.6) | <0.001 |
- T4 | 1 (1.0) | 13 (12.9) | <0.001 |
- N0 | 34 (34.0) | 47 (46.1) | 0.080 |
- N1 | 58 (58.0) | 50 (49.0) | 0.201 |
- N2 | 8 (8.0) | 5 (4.9) | 0.370 |
PDAC (n = 102) | CAMP (n = 102) | p value | |
---|---|---|---|
DGE B/C | 19 (19.0) | 24 (24.0) | 0.389 |
PPH B/C | 9 (9.9) | 6 (7.1) | 0.517 |
CR-POPF | 16 (16.8) | 31 (30.7) | < 0.001 |
Blood transfusion | 14 (13.9) | 9 (8.8) | 0.258 |
Wound infection | 20 (19.8) | 18 (18.0) | 0.744 |
Urinary tract infection | 5 (5.0) | 2 (1.0) | 0.248 |
Thrombembolism | 2 (2.0) | 3 (3.0) | 0.643 |
Intraabdominal abscess | 13 (12.9) | 12 (11.9) | 0.831 |
Pneumonia | 3 (3.0) | 3 (3.0) | 1.000 |
Reintubation | 6 (5.9) | 3 (3.0) | 0.313 |
Sepsis | 7 (6.9) | 2 (2.0) | 0.088 |
Acute kidney failure | 2 (2.0) | 0 (0.0) | 0.157 |
Insufficiency pancreaticojejunostomy | 8 (7.9) | 4 (3.9) | 0.227 |
Insufficiency pancreatogastrostomy | 4 (4.0) | 6 (5.9) | 0.527 |
Insufficiency biliodigestive anastomosis | 2 (2.0) | 1 (1.0) | 0.555 |
Postoperative mortality | 4 (4.0) | 4 (3.9) | 0.989 |
Any complication | 57 (56.4) | 66 (64.7) | 0.228 |
Surgery-related complication | 46 (45.1) | 57 (57.0) | 0.091 |
Surgical revision | 16 (15.8) | 12 (11.8) | 0.400 |
Postoperative interventional therapy (n = 201) | 30 (30.0) | 30 (29.7) | 0.963 |
Postoperative conservative therapy | 54 (54.0) | 70 (71.4) | 0.011 |
Hospital stay, days (median, range) | 18 (5 – 74) | 19 (6 – 377) | 0.354 |
Intensive Care Unit, days (median, range) | 5 (1 – 35) | 6 (2 – 52) | 0.657 |
Median overall survival, months (95%-CI) | 24 (15.7 - 32.3) | 42 (17.1 - 66.9) | 0.003 |
Univariable Cox regression | Multivariable Cox regression | |||||
---|---|---|---|---|---|---|
Parameters | HR | 95 % CI | p-value | HR | 95 % CI | p-value |
CAMP vs. PDAC | 0.45 | 0.35-0.59 | <0.001 | 0.67 | 0.50-0.89 | 0.007 |
PG | 0.70 | 0.58-0.85 | 0.702 | |||
PJ | 1.42 | 1.18-1.72 | <0.001 | 1.49 | 1.22-1.82 | <0.001 |
Laparoscopic resection | 0.74 | 0.59-0.93 | 0.008 | 0.74 | 0.59-0.93 | 0.011 |
Portal vein resection | 0.59 | 0.49-0.72 | <0.001 | |||
T1 | 0.45 | 0.0-0.68 | <0.001 | |||
T2 | 0.61 | 0.48-0.77 | <0.001 | |||
T3 | 1.89 | 1.52-2.27 | <0.001 | 1.74 | 1.39-2.18 | <0.001 |
T4 | 1.06 | 0.69-1.65 | 0.788 | 1.70 | 1.06-2.73 | 0.029 |
R0 | 0.49 | 0.39-0.60 | <0.001 | 0.59 | 0.48-0.74 | <0.001 |
R1 | 2.04 | 1.65-2.53 | <0.001 |