Introduction
Material and methods
Definitions
PPH, POPF, and DGE
Diabetes mellitus
Surgical policy
Mortality rate
Statistical analysis
Results
Incidence, mortality, classification, reason, and treatment of PPH after all pancreatectomies (Table 1
Category | Definition | All | PD | DP | TP |
---|---|---|---|---|---|
Total number of PPHs | n = 35 | n = 27 | n = 5 | n = 3 | |
Incidence of PPH | 3% (35/1169) | 4% (27/675) | 1% (5/406) | 3% (3/88) | |
Mortality among patients with PPH | 4 (11%) | 3 (11%) | 1 (20%) | 0 (0%) | |
Median onset time from initial surgery (days), (range) | 22 (0–65) | 24 (0–47) | 9 (0–27) | 2 (0–65) | |
Time of onset | Early/late | 4 (4%)/31 (96%) | 1 (4%)/26 (96%) | 1 (20%)/4 (80%) | 2 (67%)/1 (33%) |
Location | Intraluminal/extraluminal | 9 (26%)/26 (74%) | 7 (26%)/20 (74%) | 1 (20%)/4 (80%) | 1 (33%)/2 (67%) |
Severity | Mild/severe | 9 (19%)/26 (81%) | 5 (19%)/22 (81%) | 2 (40%)/3 (60%) | 2 (67%)/1 (33%) |
Reason | Pseudoaneurysm GDA/HA/SMA/SPA Bleeding from the stump of the pancreas, greater omentum or retroperitoneal | 22 (66%) 13/5/1/3 7 (19%) | 18 (66%) 12/5/1/0 5 (19%) | 3 (60%) 1/0/0/2 1 (20%) | 1 (33%) 0/0/0/1 1 (33%) |
Gastrointestinal bleeding | 6 (15%) | 4 (15%) | 1 (20%) | 1 (33%) | |
Treatment | Interventional radiology Conservative treatment with blood transfusion Endoscopic treatment Surgery Interventional radiology plus surgery | 19 (63%) 6 (15%) 5 (11%) 4 (7%) 1 (4%) | 17 (63%) 4 (15%) 3 (11%) 2 (7%) 1 (4%) | 2 (40%) 1 (20%) 1 (20%) 1 (20%) 0 (0%) | 0 (0%) 1 (33%) 1 (33%) 1 (0%) 0 (0%) |
Univariate and multivariate analyses of risk factors for PPH after all pancreatectomies (Table 2) and PPH rate by independent risk factors (Supplemental Table 2)
Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|
Risk factors | Definition | n | PPH | OR (95% CI) | P value | OR (95% CI) | P value |
Age (years) | < 65 ≥ 65 | 493 676 | 12 (2.4%) 23 (3.4%) | 1 1.41 (0.70–2.87) | 0.34 | ||
Sex | Female Male | 518 651 | 8 (1.5%) 27 (4.2%) | 1 2.76 (1.24–6.12) | 0.0013 | 1 2.32 (1.02–5.26) | 0.034 |
BMI (kg/m2) | < 25 ≥ 25 | 1011 158 | 24 (2.4%) 11 (7.0%) | 1 3.08 (1.48–6.41) | 0.0027 | 1 3.70 (1.71–8.04) | 0.0009 |
WBC (/ul) | < 8000 ≥ 8000 | 1093 76 | 3 (4.0%) 32 (2.9%) | 1 1.36 (0.41–4.56) | 0.62 | ||
Alb (g/dl) | ≥ 3.5 < 3.5 | 1040 129 | 26 (2.5%) 9 (7.0%) | 1 2.92 (1.34–6.39) | 0.0071 | 1 2.17 (0.95–4.98) | 0.066 |
CRP (mg/dl) | < 1 ≥ 1 | 1055 114 | 29 (2.8%) 6 (5.3%) | 1 1.97 (0.80–4.84) | 0.14 | ||
DM | Presence Absence | 421 748 | 6 (1.4%) 29 (3.9%) | 1 2.79 (1.15–6.78) | 0.023 | 1 3.62 (1.46–8.99) | 0.0056 |
Pretreatment * | With Without | 37 1132 | 1 (2.7%) 34 (3.0%) | 1 1.11 (0.15–8.37) | 0.92 | ||
Operative procedure | DP | 406 | 5 (1.2%) | 1 | 1 | ||
PD TP | 675 88 | 27 (4.0%) 3 (3.4%) | 3.34 (1.28–8.75) 2.83 (0.66–12.1) | 0.014 0.16 | 3.06 (1.12–8.36) 3.27 (0.73–14.7) | 0.029 0.12 | |
Operation time (min) | < 360 ≥ 360 | 597 572 | 15 (2.5%) 20 (3.5%) | 1 1.41 (0.71–2.77) | 0.33 | ||
Blood loss (ml) | < 1200 ≥ 1200 | 1010 159 | 26 (2.6%) 9 (5.7%) | 1 2.27 (1.04–4.94) | 0.039 | 1 1.50 (0.66–3.43) | 0.34 |
Vascular resection | Without | 967 | 29 (3.0%) | 1 | 0.98 | ||
With | 202 | 6 (3.0%) | 0.99 (0.41–2.42) |
Univariate and multivariate analyses of risk factors for PPH after PD (Table 3)
Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|
Risk factors | Definition | n | PPH | OR (95% CI) | P value | OR (95% CI) | P value |
Period | 2005–2011 2012–2018 | 324 351 | 9 (2.8%) 18 (5.1%) | 1 1.89 (0.84–4.27) | 0.12 | ||
Age (years) | < 65 ≥ 65 | 251 424 | 8 (3.2%) 19 (4.5%) | 1 1.43 (0.61–3.30) | 0.41 | ||
Sex | Female Male | 264 411 | 7 (2.7%) 20 (4.9%) | 1 1.88 (0.78–4.51) | 0.15 | ||
BMI (kg/m2) | < 25 ≥ 25 | 595 80 | 20 (3.4%) 7 (8.8%) | 1 2.76 (1.13–6.74) | 0.021 | 1 2.22 (0.77–6.43) | 0.14 |
WBC (/ul) | < 8000 ≥ 8000 | 628 47 | 25 (4.0%) 2 (4.3%) | 1 1.07 (0.25–4.67) | 0.93 | ||
Alb (g/dl) | ≥ 3.5 < 3.5 | 563 112 | 17 (3.0%) 10 (8.9%) | 1 2.68 (1.17–6.12) | 0.016 | 1 2.04 (0.79–5.28) | 0.14 |
CRP (mg/dl) | < 1 ≥ 1 | 577 98 | 22 (3.8%) 5 (5.1%) | 1 1.36 (0.50–3.67) | 0.56 | ||
DM | Presence Absence | 241 434 | 4 (1.7%) 23 (5.3%) | 1 3.32 (1.13–9.70) | 0.021 | 1 3.45 (1.06–11.3) | 0.040 |
Pre-drainage | Without With | 404 271 | 13 (3.2%) 14 (5.2%) | 1 1.64 (0.76–3.54) | 0.21 | ||
Pretreatment * | With Without | 29 646 | 1 (3.5%) 26 (4.0%) | 1 1.17 ‘0.15–8.97) | 0.87 | ||
Operation time (min) | < 360 ≥ 360 | 220 455 | 9 (4.1%) 18 (4.0%) | 1.04 (0.46–2.34) 1 | 0.93 | ||
Blood loss (ml) | < 1200 ≥ 1200 | 566 109 | 18 (3.2%) 9 (8.4%) | 1 2.81 (1.23–6.43) | 0.011 | 1 1.74 (0.65–4.66) | 0.27 |
Vascular resection | Without With | 566 109 | 22 (3.9%) 5 (4.6%) | 1 1.19 (0.44–3.21) | 0.73 | ||
PJ anastomosis method | Duct-to mucosa Modified Blumgart | 580 95 | 23 (4.0%) 4 (4.2%) | 1 1.06 (0.36–3.15) | 0.91 | ||
Falciform ligament wrapping of GDA stump | Without With | 399 276 | 16 (2.8%) 11 (5.7%) | 1 2.13 (0.97–4.66) | 0.059 | ||
Clipping of GDA stump | Without With | 657 18 | 26 (4.0%) 1 (5.6%) | 1 1.43 (0.18–11.1) | 0.75 | ||
PJ stent | Without With | 318 357 | 8 (2.5%) 19 (5.3%) | 1 | |||
2.18 (0.94–5.05) | 0.059 | ||||||
Pathological tissue type | PDAC IPMN DEBDC PVC Others | 261 139 149 75 50 | 6 (2.3%) 3 (2.2%) 12 (8.1%) 4 (5.3%) 2 (4.0%) | 1 | 1 | ||
0.94 (0.23–3.82) 3.74 (1.37–10.2) 2.40 (0.66–8.75) 1.78 (0.35–9.07) | 0.93 0.010 0.18 0.49 | 1.13 (0.22–5.72) 1.49 (0.47–4.75) 0.81 (0.19–3.49) 2.14 (0.34–13.3) | 0.88 0.50 0.78 0.42 | ||||
POPF** | None or A B or C | 542 133 | 3 (0.6%) 24 (18.1%) | 1 39.6 (11.8–133.7) | < 0.0001 | 1 31.7 (8.94–112.2) | < 0.0001 |
DGE*** | None or A B or C | 626 49 | 25 (4.0%) 2 (4.1%) | 1 1.02 (0.23–4.45) | 0.98 | ||
Bile leakage | Without With | 665 10 | 26 (3.9%) 1 (10.0%) | 1 2.73 (0.33–22.4) | 0.33 |
Univariate and multivariate analyses of risk factors for POPF after PD (Table 4)
Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|
Risk factors | Definition | n | POPF | OR (95% CI) | P value | OR (95% CI) | P value |
Age (years) | < 65 ≥ 65 | 251 424 | 42 (16.8%) 91 (21.5%) | 1 1.36 (0.91–2.04) | 0.14 | ||
Gender | Female Male | 264 411 | 37 (14.0%) 96 (23.4%) | 1 1.87 (1.23–2.83) | 0.0024 | 1 1.57 (0.99–2.46) | 0.05002 |
BMI (kg/m2) | < 25 ≥ 25 | 595 80 | 106 (17.8%) 27 (33.8%) | 1 2.35 (1.41–3.91) | 0.0015 | 1 3.17 (1.81–5.56) | < 0.0001 |
WBC (/ul) | < 8000 ≥ 8000 | 628 47 | 120 (19.1%) 13 (27.7%) | 1 1.62 (0.83–3.16) | 0.16 | ||
Alb (g/dl) | ≥ 3.5 < 3.5 | 563 112 | 99 (17.6%) 34 (30.4%) | 1 1.93 (1.22–3.06) | 0.0050 | 1 1.77 (1.07–2.93) | 0.027 |
CRP (mg/dl) | < 1 ≥ 1 | 577 98 | 108 (18.7%) 25 (25.5%) | 1 1.49 (0.90–2.45) | 0.12 | ||
DM | Presence Absence | 241 434 | 35 (14.5%) 98 (22.6%) | 1 1.72 (1.12–2.62) | 0.0123 | 1 1.75 (1.10–2.78) | 0.019 |
Pre-drainage | Without With | 404 271 | 65 (16.1%) 68 (25.1%) | 1 1.75 (1.19–2.56) | 0.0042 | 1 0.69 (0.40–1.17) | 0.17 |
Pretreatment * | With Without | 646 29 | 126 (19.5%) 7 (24.1%) | 1 1.31 (0.55–3.14) | 0.54 | ||
Pathological tissue type | PDAC IPMN DEBDC PVC Others | 262 139 149 75 50 | 30 (11.5%) 18 (13.0%) 49 (32.9%) 29 (38.7%) 7 (14.0%) | 1 | 1 | ||
1.15 (0.62–2.15) 3.79 (2.27–6.32) 4.88 (2.67–8.89) 1.26 (0.52–3.05) | 0.66 < 0.0001 < 0.0001 0.61 | 1.14 (0.60–2.20) 4.05 (2.15–7.62) 5.19 (2.70–9.97) 1.05 (0.42–2.65) | 0.69 < 0.0001 < 0.0001 0.92 |