Background
Methods
Patients
n= | |
---|---|
Sex (m/f) | 103 (53%)/92 (47%) |
Age y (±SD) | 67.0 (± 9.7) 95% CI 63.3-66.1 |
Hypertension (yes/no) | 100 (51.3%)/95 (48.7%) |
Preoperative diabetes mellitus
| |
(yes/no) | 69 (35.4%)/126 (64.6%) |
Obstructive jaundice (yes/no) | 159 (81.5%)/36 (18.5%) |
Preoperative biliary stent (yes/no) | 139 (71.3%)/56 (28.7%) |
Alcohol abuse (yes/no) | 64 (32.8%)/131 (67.2%) |
Nicotine abuse (yes/no) | 35 (17.9%)/160 (82.1%) |
Pack-years (±SD) | 20 (± 6.5 y) |
BMI (m/kg2) | 24.8 (± 3.6) 95% CI 24.5-25.5 |
General condition
| |
Good | 150 (76.9%) |
Mediocre | 43 (22.1%) |
Poor | 2 (1.0%) |
Operations
Data collection
Definitions
Statistical analysis
Results
Patient demographics and preoperative parameters
Intraoperative parameters
Indication for operation*
| |
---|---|
Pain (%) | 1.5 |
Suspicion of malignancy (%) | 98.5 |
Obstructive jaundice (%) | 20.0 |
Gastric outlet obstruction (%) | 1.0 |
Performed procedures
| |
Whipple (%) | 30.3 |
PPPD (%) | 69.7 |
Resection of the SMV/portal vein (%) | 29.7 |
Mean operative time (minutes) SD | 420.88 ± 99.0 |
Postoperative hospital stay (days) | 19.02 (range 7–100) |
Postoperative ICU stay (days) | 5.24 (range 0–69) |
Morbidity and mortality
Complication/morbidity
|
Patients with complication
*
|
---|---|
n = 81 (42%)
| |
POPF
| |
Grade B | n = 10 (5.1%) |
Grade C | n = 3 (1.5%) |
PPH
| |
Grade B | n = 5 (2.6%) |
Grade C | n = 3 (1.5%) |
DGE
| |
Grade B | n = 13 (6.7%) |
Grade C | n = 5 (3.6%) |
Other complications
| |
Wound infections | n = 30 (15.4%) |
Postoperative pneumonia | n = 10 (5.1%) |
Pancreatitis | n = 8 (4.1%) |
Cholangitis | n = 3 (1.5%) |
Urinary tract infection | n = 7 (3.6%) |
Anastomotic leakage
| |
Hepaticojejunostomy | n = 8 (4.1%) |
Pancreatojejunostomy | n = 16 (8.2%) |
In-hospital mortality
| n = 8 (4.1%) |
Histological analysis of the specimen
TNM (2007) | |
---|---|
Tumor stage
| |
pT1 | 7 (3.6%) |
pT2 | 12 (6.1%) |
pT3 | 173 (88.8%) |
pT4 | 3 (1.5%) |
Nodal status
| |
pN0 | 66 (33.8%) |
pN1 | 124 (63.6%) |
pN1b | 5 (2.6%) |
Interaortocaval metastasis
| |
M1 | 15 (7.7%) |
Resectional status
| |
R0 | 138 (70.8%) |
R1 | 42 (21.5%) |
R2 | 10 (5.1%) |
Rx | 5 (2.6%) |
Perineural invasion
| |
PN0 | 76 (39.0%) |
PN1 | 116 (59.5%) |
PNx | 3 (1.5%) |
Tumor differentiation
| |
G1 | 6 (3.1%) |
G2 | 102 (52.3%) |
G3 | 82 (42.0%) |
G4 | 5 (2.6%) |
Survival
Univariate survival analysis
3-year survival |
p Value | |
---|---|---|
Age (years)
| 0.073 | |
<60 (n = 74) | n = 22 (30%) | |
61-65 (n = 100) | n = 18 (18%) | |
>65 (n = 21) | n = 2 (9%) | |
CEA (ng/ml)
|
0.002
| |
<4 (n = 151)
|
n = 39 (26%)
| |
>4 (n = 36)
|
n = 1 (3%)
| |
CA 19–9 (U/ml)
|
0.026
| |
<24 (n = 39)
|
n = 13 (33%)
| |
>24 (n = 151)
|
n = 26 (17%)
| |
T- stage
| 0.894 | |
pT1 n = 7 | n = 2 (28%) | |
pT2 n = 12 | n = 2 (17%) | |
pT3 n = 173 | n = 37 (21%) | |
pT4 n = 3 | n = 1 (33%) | |
R-status
| 0.155 | |
R0 n = 138 | n = 30 (22%) | |
R1 n = 42 | n = 8 (19%) | |
R2 n = 10 | n = 1 (10%) | |
Lymph node-ratio
| 0.709 | |
<0.2 (n = 134) | n = 30 (22%) | |
≥0.2 (n = 60) | n = 12 (20%) | |
Tumor grade
|
0.001
| |
G1 (n = 6)
|
n = 4 (67%)
| |
G2 (n = 102)
|
n = 21 (20%)
| |
G3 (n = 82)
|
n = 12 (15%)
| |
G4 (n = 5)
|
n = 2 (40%)
| |
Pancreas texture
|
0.017
| |
Hard n = 33
|
n = 2 (6%)
| |
Soft n = 161
|
n = 40 (25%)
| |
Preoperative diabetes (n = 69) | n = 12 (17%) | 0.365 |
Nicotine abuse (n = 35) | n = 6 (17%) | 0.651 |
Hypertension (n = 100) | n = 18 (18%) | 0.163 |
BMI >35 (n = 3) | 0 | 0.631 |
POPF grade B (n = 10) | n = 4 (40%) | 0.228 |
POPF grade C (n = 3) | n = 1 (33%) | 0.387 |
Multivariate survival analysis
HR | 95% Confidence Interval HR | P value | |||
---|---|---|---|---|---|
Lower | Upper | ||||
Step 1
| Age | 1.205 | 0,916 | 1,549 | 0.162 |
CEA >3 ng/ml | 2.293 | 1,488 | 3,628 | <0.001 | |
CA 19–9 >75 U/ml | 1.130 | 0,721 | 1,671 | 0.560 | |
Tumor-grade 3 | 1.312 | 1,032 | 1,685 | 0.027 | |
Pan. Texture (hard) | 1.046 | 0,590 | 1,713 | 0.866 | |
Step 2
| Age | 1.203 | 1,489 | 3,626 | 0.164 |
CEA >3 ng/ml | 2.297 | 0,916 | 1,547 | <0.001 | |
CA 19–9 >75 U/ml | 1.136 | 0,724 | 1,667 | 0.539 | |
Tumor-grade 3 | 1.313 | 1,032 | 1,685 | 0.027 | |
Step 3
| Age | 1.215 | 0,917 | 1,547 | 0.142 |
CEA >3 ng/ml | 2.258 | 1,490 | 3,627 | <0.001 | |
Tumor-grade 3 | 1.330 | 1,035 | 1,683 | 0.565 | |
Step 4
| |||||
CEA >3 ng/ml | 2.350 | 1,518 | 3,639 | <0.001 | |
Tumor-grade 3 | 1.346 | 1,064 | 1,702 | 0.013 |