Background
Methods
Patients and data collection
Techniques of PE
The surgical technique for modified duct-to-mucosa PE
The conventional end-to-side inserting PE
PSM analysis
Variables | Group (before PSM) | Group (after PSM) | ||||
---|---|---|---|---|---|---|
A (n = 124) | B (n = 109) | P value | A (n = 82) | B (n = 82) | P value | |
Performance status (0:1:2) | 119:5:0 | 105:4:0 | 0.580 | 78:4:0 | 80:2:0 | 0.682 |
Gender (female/male) | 50:74 | 58:51 | 0.033 | 37:45 | 39:43 | 0.754 |
Age (years), n (%) | ||||||
< 45 | 10 (8.1) | 2 (1.8) | 0.037 | 8 (9.8) | 1 (1.2) | 0.696 |
45–55 | 38 (30.6) | 28 (25.7) | 23 (28.0) | 27 (32.9) | ||
56–65 | 50 (40.3) | 61 (56.0) | 34 (41.5) | 43 (52.4) | ||
> 65 | 26 (21.0) | 18 (16.5) | 17 (20.7) | 11 (13.4) | ||
ASA, n (%) | ||||||
I | 120 (96.8) | 105 (96.3) | 0.566 | 78 (95.1) | 82 (97.6) | 0.405 |
II | 4 (3.2) | 4 (3.7) | 4 (4.9) | 2 (2.4) | ||
III | 0 | 0 | 0 | 0 | ||
IV.V | 0 | 0 | 0 | 0 | ||
BMI (kg/m2), n (%) | ||||||
< 24 | 90 (54.2) | 76 (45.8) | 0.037 | 64 (78.0) | 60 (73.2) | 0.502 |
24–28 | 33 (60.0) | 22 (40.0) | 17 (20.7) | 21 (25.6) | ||
> 28 | 11 (91.7) | 1 (8.3) | 1 (1.2) | 1 (1.2) | ||
Previous laparotomy, n (%) | 5 (4.0) | 14 (12.8) | 0.014 | 5 (6.1) | 7 (8.5) | 0.549 |
Jaundice, n (%) | 50 (40.3) | 66 (60.6) | 0.002 | 47 (57.3) | 44 (53.7) | 0.637 |
Cholangitis, n (%) | 33 (26.6) | 44 (40.4) | 0.026 | 29 (35.4) | 30 (36.6) | 0.871 |
Weight loss, n (%) | 38 (44.2) | 48 (55.8) | 0.035 | 29 (35.4) | 28 (34.1) | 0.870 |
Tumor size, n (%) | ||||||
< 2 cm | 44 (35.5) | 29 (26.6) | 0.026 | 25 (30.5) | 22 (26.8) | 0.869 |
2–4 cm | 56 (45.2) | 68 (62.4) | 47 (57.3) | 49 (59.8) | ||
> 4 cm | 24 (19.4) | 12 (11.0) | 10 (12.2) | 11 (13.4) | ||
HB (g/L), n (%) | ||||||
≧ 10 | 111 (89.5) | 91 (83.5) | 0.176 | 74 (90.2) | 71 (86.6) | 0.464 |
< 10 | 13 (10.5) | 18 (16.5) | 8 (9.8) | 11 (13.4) | ||
ALB (g/L), n (%) | ||||||
≧ 35 | 90 (72.6) | 63 (57.8) | 0.018 | 54 (65.9) | 51 (62.2) | 0.625 |
< 35 | 34 (27.4) | 46 (42.2) | 28 (34.1) | 31 (37.8) | ||
Preoperative bile duct drainage, n (%) | 30 (24.2) | 40 (36.7) | 0.038 | 27 (32.9) | 26 (31.7) | 0.867 |
Comorbidities, n (%) | ||||||
Diabetes | 18 (14.5) | 28 (25.7) | 0.033 | 13 (15.9) | 16 (19.5) | 0.539 |
Respiratory disease | 11 (8.9) | 12 (11.0) | 0.585 | 6 (7.3) | 6 (7.3) | > 0.999 |
Ischemic heart disease | 10 (8.1) | 8 (7.3) | 0.836 | 7 (8.5) | 6 (7.3) | 0.773 |
Hypertension | 40 (32.3) | 30 (27.5) | 0.431 | 22 (26.8) | 23 (28.0) | 0.861 |
Pancreatic duct diameter, n (%) | ||||||
< 3 mm | 19 (15.3) | 30 (27.5) | 0.023 | 14 (17.1) | 16 (19.5) | 0.686 |
≧ 3 mm | 105 (84.7) | 79 (72.5) | 68 (82.9) | 66 (80.5) | ||
Pancreas texture, n (%) | ||||||
Soft | 37 (29.8) | 35 (32.1) | 0.708 | 22 (26.8) | 23 (28.0) | 0.861 |
Firm | 87 (70.2) | 74 (67.9) | 60 (73.2) | 59 (72.0) |
Definition of postoperative complications
Statistical analysis
Results
Clinical characteristics of patients before and after PSM
Operative findings and postoperative outcomes in the PSM model
Operative time (min) | Group A (n = 82) | Group B (n = 82) | P value |
---|---|---|---|
214.6 ± 28.5 | 229.8 ± 26.5 | < 0.001 | |
Pancreaticoenterostomy time (min) | 9.3 ± 1.8 | 21.5 ± 2.8 | < 0.001 |
Blood loss (ml) | 314.4 ± 147.6 | 349.9 ± 132.4 | 0.107 |
Intra-operative blood transfusion (ml), n (%) | |||
None | 44 (53.7) | 27 (32.9) | 0.025 |
≦ 600 | 17 (20.7) | 27 (32.9) | |
> 600 | 21 (25.6) | 28 (34.1) | |
Delayed gastric emptying, n (%) | 4 (4.9) | 9 (11.0) | 0.148 |
ICU transfer, n (%) | 4 (4.9) | 6 (7.3) | 0.514 |
Postoperative hospital stay (days) | 15.1 ± 2.8 | 17.74 ± 4.9 | 0.008 |
Final diagnosis, n (%) | |||
Pancreatic cancer | 42 (51.2) | 33 (40.2) | 0.158 |
Bile duct cancer | 7 (8.5) | 7 (8.5) | > 0.999 |
Intraductal papillary mucinous neoplasm | 8 (9.8) | 9 (11.0) | 0.798 |
Vater’s papilla cancer | 5 (6.1) | 4 (4.9) | 0.732 |
Neuroendocrine tumor | 4 (4.9) | 6 (7.3) | 0.514 |
Metastasis from other organs | 6 (7.3) | 5 (6.1) | 0.755 |
GIST | 1 (1.2) | 3 (3.7) | 0.620 |
Chronic pancreatitis | 1 (1.2) | 6 (7.3) | 0.053 |
Solid pseudopapillary tumor | 6 (7.3) | 6 (7.3) | > 0.999 |
Duodenal cancer | 2 (2.4) | 3 (3.7) | 0.650 |
Postoperative complications in the PSM model
Group A (n = 82) | Group B (n = 82) | P value | |
---|---|---|---|
Biochemical leak, n (%) | 15 (18.3) | 21 (25.6) | 0.258 |
CR-POPF, n (%) | 1 (1.2) | 12 (19.5) | < 0.001 |
Grade B | 1 (1.2) | 10 (12.2) | 0.005 |
Grade C | 0 | 2 (2.4) | 0.497 |
Post-pancreatectomy hemorrhage, n (%) | 0 | 4 (4.9) | 0.043 |
GI anastomotic fistula, n (%) | 0 | 2 (2.4) | 0.497 |
Intra-abdominal infection, n (%) | 3 (3.7) | 10 (12.2) | 0.043 |
Chylous fistula, n (%) | 3 (3.7) | 1 (1.2) | 0.620 |
Septicemia, n (%) | 1 (1.2) | 2 (2.4) | 0.556 |
Gastrointestinal hemorrhage, n (%) | 3 (3.7) | 1 (1.2) | 0.620 |
Biliary fistula, n (%) | 2 (2.4) | 3 (3.7) | 0.650 |
Organ failure, n (%) | 1 (1.2) | 2 (2.4) | 0.500 |
In-hospital mortality | 0 | 2 (2.4) | 0.497 |
Readmission (< 1 month) | 1 (1.2) | 2 (2.4) | 0.500 |
Mortality, 90 days | 0 | 1 (1.2) | 0.316 |
Clavien–Dindo classification | |||
Mild–moderate (grade I–II), n (%) | 18 (22.0) | 29 (35.4) | 0.057 |
Severe (grade III–V), n (%) | 5 (7.3) | 14 (17.1) | 0.028 |
Postoperative complications (total), n (%) | 23 (28.0) | 43 (52.4) | 0.001 |
Risk factors for pancreatic fistula
Variable | Univariate | Multivariate | |||
---|---|---|---|---|---|
With CR-POPF, n (%) | Without CR-POPF, n (%) | P value | Relative risk (95% CI) | P value | |
PE approach | < 0.001 | 0.009 | |||
End-to-side | 17 (15.6) | 92 (84.4) | 1 | ||
Duct-to-mucosa | 1 (0.8) | 123 (99.2) | 0.11 (0.02–0.57) | ||
BMI (kg/m2) | < 0.001 | < 0.001 | |||
< 24 | 5 (3.0) | 161 (97.0) | Ref. | – | |
24–28 | 6 (10.9) | 49 (89.1) | 11.89 (2.14–65.94) | 0.005 | |
> 28 | 7 (58.3) | 5 (41.7) | 49.39 (5.20–469.19) | < 0.001 | |
Diabetes | < 0.001 | 0.001 | |||
No | 6 (3.2) | 181 (96.8) | 1 | ||
Yes | 12 (26.1) | 34 (73.9) | 10.54 (2.55–43.61) | ||
Final diagnosis | 0.016 | 0.324 | |||
Pancreatic cancer | 6 (4.3) | 134 (95.7) | 1 | ||
Other pathologic findings | 12 (12.9) | 81 (87.1) | 2.24 (0.45–11.10) | ||
Pancreas texture | 0.018 | 0.480 | |||
Firm | 8 (5.0) | 153 (95.0) | 1 | ||
Soft | 10 (13.9) | 62 (86.1) | 1.81 (0.35–9.45) | ||
Pancreatic duct diameter | 0.029 | 0.021 | |||
≧ 3 mm | 10 (5.4) | 174 (94.6) | 1 | ||
< 3 mm | 8 (16.3) | 41 (83.7) | 6.72 (1.33–33.88) | ||
Neoplastic | 0.175 | 0.865 | |||
No | 2 (20.0) | 8 (80.0) | 1 | ||
Yes | 16 (7.2) | 207 (92.8) | 0.73 (0.02–26.69) |
Variable | Univariate | Multivariate | |||
---|---|---|---|---|---|
With CR-POPF, n (%) | Without CR-POPF, n (%) | P value | Relative risk (95% CI) | P value | |
PE approach | 0.034 | 0.156 | |||
End-to-side | 8 (9.8) | 74 (90.2) | 1 | ||
Duct-to-mucosa | 1 (1.2) | 81 (98.8) | 0.19 (0.02–1.88) | ||
BMI (kg/m2) | 0.090 | 0.030 | |||
< 24 | 4 (3.2) | 120 (96.8) | 1 | – | |
24–28 | 5 (13.2) | 33 (86.8) | 15.75 (2.04–121.40) | 0.008 | |
> 28 | 0 (0.0) | 2 (100.0) | 0.00 (0.00–0.00) | 1.000 | |
Diabetes | < 0.001 | 0.005 | |||
No | 3 (2.2) | 132 (97.8) | 1 | ||
Yes | 6 (20.7) | 23 (79.3) | 14.01 (2.20–89.19) | ||
Final diagnosis | 0.936 | 0.791 | |||
Pancreatic cancer | 4 (5.3) | 71 (94.7) | 1 | ||
Other pathologic findings | 5 (5.6) | 84 (94.4) | 0.71 (0.06–8.99) | ||
Pancreas texture | 0.707 | 0.817 | |||
Firm | 6 (5.0) | 113 (95.0) | 1 | ||
Soft | 3 (6.7) | 42 (93.3) | 0.75 (0.07–8.38) | ||
Pancreatic duct diameter | 0.213 | 0.114 | |||
≧ 3 mm | 6 (4.5) | 128 (95.5) | 1 | ||
< 3 mm | 3 (10.0) | 27 (90.0) | 5.39 (0.67–43.63) | ||
Neoplastic | 0.021 | ||||
No | 2 (28.6) | 5 (71.4) | 0.049 | 1 | |
Yes | 7 (4.5) | 150 (95.5) | 0.03 (0.00–0.59) |