Background
Methods
Study design and patient cohort
Inclusion and exclusion criteria
Definition of variables
Study endpoints
Statistical analysis
Results
Study cohort and preoperative course
Variables | nabs (n%) | Mean; Median (Range) | Missing values n (%) | ||
---|---|---|---|---|---|
Biometrics | Female gender | 48 (51.1) | 0 (0.0) | ||
Age (in years) | 65.0; 65.0 (41-84) | 0 (0.0) | |||
Preoperative Course | Initial symptoms | Epigastric pain | 64 (68.1) | 4 (4.3) | |
Weight loss | 37 (39.4) | ||||
Back pain | 19 (20.2) | ||||
Inappetence | 13 (13.8) | ||||
Nausea | 12 (12.8) | ||||
Vomiting | 6 (6.4) | ||||
Fatigue | 6 (6.4) | ||||
Others | 29 (30.9) | ||||
ASA score | 1 | 7 (7.4) | 16 (17.0) | ||
2 | 49 (52.1) | ||||
3 | 22 (23.4) | ||||
Diabetes | 20 (21.3) | 3 (3.2) | |||
Diagnostics | Hemoglobin (in g/dl) | 13.4; 13.3 (9.9-17.2) | 2 (2.1) | ||
Anemia | 14 (14.9) | ||||
Platelets (in 10³ per μl) | 237.85; 236 (56-551) | 2 (2.1) | |||
Elevated CA19-9 | 42 (44.7) | 31 (33.0) | |||
Elevated CEA | 19 (20.2) | 34 (36.2) | |||
CT scan | 82 (87.2) | 4 (4.3) | |||
MRI scan | 5 (5.3) | 4 (4.3) | |||
Ultrasound | 74 (78.7) | 13 (13.8) | |||
Preoperative hospital stay (in days) | 2.82; 2 (1-20) | 1 (1.1) | |||
Surgical details | Type of pancreatectomy | Distal | 85 (90.4) | 0 (0.0) | |
Subtotal | 9 (9.6) | ||||
Splenectomy | 93 (98.9) | 0 (0.0) | |||
Multivisceral resection | 47 (50.0) | 0 (0.0) | |||
Including (partial) resection of | Liver | 12 (12.8) | |||
Large intestine | 12 (12.8) | ||||
Small intestine | 8 (8.5) | ||||
Stomach | 14 (14.9) | ||||
Kidney | 5 (5.3) | ||||
Adrenal gland | 13 (13.8) | ||||
Coeliac trunk | 5 (5.3) | ||||
Portal vein | 15 (16.0) | ||||
Intraoperative PRBC | 34 (36.2) | 0 (0.0) | |||
Intraoperative PRBC (n) | 1.34; 0 (0-24) | ||||
Intraoperative FFP | 15 (16.0) | 0 (0.0) | |||
Operation time (in minutes) | 165.62; 155 (68-360) | 2 (2.1) | |||
Histopathological results | Tumor localization | Tail | 42 (44.7) | 0 (0.0) | |
Body | 40 (42.6) | ||||
Tail and body | 12 (12.8) | ||||
Including body | 52 (55.3) | ||||
Invasion of peripancreatic tissue | 78 (83.0) | 0 (0.0) | |||
T staging | Tumor size (in cm) | 4.79; 4.5 (1.0-14.0) | 0 (0.0) | ||
1 | 7 (7.4) | 0 (0.0) | |||
2 | 37 (39.4) | ||||
3 | 45 (47.9) | ||||
4 | 5 (5.3) | ||||
T stage ≥ 3 | 50 (53.2) | ||||
Lymph node status | Lymph nodes (n total) | 11.86; 10 (1-36) | 3 (3.2) | ||
Lymph nodes (n positive) | 1.22; 0 (0-8) | ||||
Lymph node ratio (in %) | 11.68; 0 (0-100) | ||||
Lymph node ratio ≥ 20% | 24 (25.5) | ||||
N 0 stage | 49 (52.1) | 2 (2.1) | |||
N 1 stage | 34 (36.2) | ||||
N 2 stage | 9 (9.6) | ||||
≥ N 1 stage | 43 (45.7) | ||||
M 1 stage | 19 (20.2) | 0 (0.0) | |||
Grading | 1 | 1 (1.1) | 0 (0.0) | ||
2 | 56 (59.6) | ||||
3 | 37 (39.4) | ||||
Resection margin | 0 | 61 (64.9) | 0 (0.0) | ||
1 | 26 (27.7) | ||||
2 | 7 (7.4) | ||||
≥ R1 | 33 (35.1) | ||||
AJCC/UICC classification (8th ed.) | Ia | 6 (6.4) | 2 (2.1) | ||
Ib | 15 (16.0) | ||||
IIa | 16 (17.0) | ||||
IIb | 24 (25.5) | ||||
III | 12 (12.8) | ||||
IV | 19 (20.2) | ||||
≥ III | 31 (33.0) |
Pancreatic surgery
Variables | nabs (n%) | Mean; Median (Range) | Missing values n (%) | |
---|---|---|---|---|
Hospital stay (in days) | 19.33; 15 (5-109) | 0 (0.0) | ||
Complications requiring surgery | 8 (8.5) | 0 (0.0) | ||
Complications not requiring surgery | 33 (35.1) | |||
Pancreatic fistula | Not measured | 47 (50.0) | 2 (2.1) | |
No biochemical leak | 17 (18.1) | |||
Biochemical leak (former Grade A) | 6 (6.4) | |||
Grade B | 17 (18.1) | |||
Grade C | 5 (5.3) | |||
≥ Grade B | 22 (23.4) | |||
Postoperative days until removal of drains | 12.75; 9 (3-46) | 3 (3.2) | ||
Pancreatin post-surgery | 34 (36.2) | 7 (7.4) | ||
In-hospital mortality | 6 (6.4) | 0 (0.0) | ||
Follow-up time in months | 23.18; 12.90 (0.16-220.92) | 0 (0.0) | ||
Survival in months (Kaplan-Meier) | 27.96; 12.78 (n.a.) | 0 (0.0.) | ||
1-year survival (Kaplan-Meier) | n.a. (53.2) | |||
3-year survival (Kaplan-Meier) | n.a. (15.8) | |||
5-year survival (Kaplan-Meier) | n.a. (9.0) | |||
Deceased at time of analysis | 88 (93.6) | 0 (0.0) |
Histopathological results
Postoperative outcome
Risk factors for clinically relevant pancreatic fistulas
Risk factors for postoperative survival
Variables | Univariable analysis | Multivariable analysis | ||||||
---|---|---|---|---|---|---|---|---|
HR | CI 95% | p value | HR | CI 95% | p value | |||
Biometrics | Female gender | 0.770 | 0.506–1.171 | 0.222 | ||||
Age (in years) | 1.003 | 0.980–1.027 | 0.805 | |||||
Preoperative course | Initial symptoms | Epigastric pain | 0.946 | 0.592–1.512 | 0.817 | |||
Weight loss | 1.202 | 0.777–1.861 | 0.408 | |||||
Back pain | 1.489 | 0.890–2.491 | 0.130 | |||||
Inappetence | 1.512 | 0.817–2.798 | 0.188 | |||||
Nausea | 0.702 | 0.362–1.362 | 0.296 | |||||
Vomiting | 0.881 | 0.356–2.182 | 0.785 | |||||
Fatigue | 3.007 | 1.279–7.071 | 0.012 | |||||
Others | 1.060 | 0.666–1.687 | 0.806 | |||||
ASA score > 2 | 1.362 | 0.823–2.255 | 0.229 | |||||
Diabetes | 1.236 | 0.740–2.066 | 0.419 | |||||
Diagnostics | Hemoglobin (in g/dl) | 0.973 | 0.821–1.154 | 0.756 | ||||
Anemia | 1.442 | 0.793–2.621 | 0.231 | |||||
Platelets (in 103 per μl) | 0.996 | 0.993–1.000 | 0.047 | |||||
Elevated CA19-9 | 1.480 | 0.853–2.568 | 0.163 | |||||
Elevated CEA | 0.848 | 0.478–1.504 | 0.572 | |||||
Surgical details | Type of pancreatectomy | More than distal | 1.060 | 0.530–2.121 | 0.869 | |||
Multivisceral resection | 1.208 | 0.794–1.839 | 0.378 | |||||
Including (partial) resection of | Liver | 1.386 | 0.750–2.562 | 0.298 | ||||
Large intestine | 1.207 | 0.654–2.228 | 0.548 | |||||
Small intestine | 1.198 | 0.577–2.485 | 0.628 | |||||
Stomach | 1.184 | 0.665–2.107 | 0.567 | |||||
Kidney | 1.581 | 0.636–3.928 | 0.324 | |||||
Adrenal gland | 1.120 | 0.608–2.060 | 0.717 | |||||
Coeliac trunk | 3.091 | 1.226–7.797 | 0.017 | 3.364 | 1.147–9.861 | 0.027 | ||
Portal vein | 1.711 | 0.962–3.044 | 0.067 | 2.275 | 1.221–4.236 | 0.010 | ||
Intraoperative PRBC | 2.235 | 1.429–3.498 | < 0.001 | 1.998 | 1.229–3.247 | 0.005 | ||
Intraoperative PRBC (n) | 1.160 | 1.080–1.245 | < 0.001 | |||||
Intraoperative FFP | 1.808 | 1.024–3.191 | 0.041 | |||||
Operation time (in minutes) | 1.004 | 1.000–1.009 | 0.033 | |||||
Histopathological results | Tumor localization | Including body | 1.053 | 0.691–1.604 | 0.811 | |||
Invasion of peripancreatic tissue | 2.148 | 1.182–3.904 | 0.012 | |||||
T staging | Tumor size (in cm) | 1.060 | 0.983–1.143 | 0.132 | ||||
T stage ≥ 3 | 1.558 | 1.019–2.381 | 0.040 | |||||
Lymph node status | Lymph nodes (n, total) | 0.985 | 0.958–1.012 | 0.271 | ||||
Lymph nodes (n, positive) | 1.201 | 1.065–1.355 | 0.003 | |||||
Lymph node ratio (in %) | 1.020 | 1.008–1.033 | 0.002 | 1.022 | 1.009–1.034 | 0.001 | ||
≥ N 1 stage | 1.688 | 1.100–2.592 | 0.017 | |||||
N 2 stage | 2.095 | 1.027–4.274 | 0.042 | |||||
M 1 stage | 1.381 | 0.825–2.311 | 0.219 | |||||
Grading | Grading > 2 | 1.266 | 0.826–1.939 | 0.279 | ||||
Resection margin | ≥ R1 | 1.892 | 1.219–2.935 | 0.004 | ||||
R 2 status | 1.008 | 0.464–2.189 | 0.984 | |||||
AJCC/UICC classification (8th ed.) | ≥ III | 1.815 | 1.149–2.868 | 0.011 |