Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability

Table 1 Preoperative clinical parameters

Variables	Group 1	Group 2	P value
	(n = 46)	(n = 32)
Age (yr)	67 (37-82)	63 (35-86)	0.452
Male:female, n	25:21	20:12	0.473
Presence of comorbid illness	25 (54.3)	16 (50.0)	0.705
Cardiovascular disease	15 (32.6)	9 (28.1)	0.673
Pulmonary disease	5 (10.9)	1 (3.1)	0.406
Renal disease	2 (4.3)	1 (3.1)	1.000
Diabetes Mellitus	9 (19.6)	11 (34.4)	0.141
Hemoglobin (g/dL)	12.5 (9.0-15.6)	12.7 (9.5-15.6)	0.614
White blood cell count (× 109/L)	6.9 (3.6-21.2)	6.7 (3.9-13.1)	0.763
Prothrombin time (s)	11.4 (9.8-40.8)	11.3 (9.0-14.4)	0.421
International normalized ratio	1.0 (0.8-3.6)	1.0 (0.8-1.2)	0.938
Serum creatinine (mmol/L)	75 (52-212)	84 (47-143)	0.607
Serum bilirubin ( mmol/L)	102 (5-533)	38 (5-342)	0.020
Albumin (g/L)	39 (27-46)	40.5 (8-47)	0.041

Data are expressed as median (range), or n (%).

Table 2 Operation details n (%)

Variables	Group 1	Group 2	P value
	(n = 46)	(n = 32)
Portal vein resection	-	18 (56.3)	-
Reconstruction method	-		-
Primary anastomosis		14 (77.8)
Cadaveric vein graft		3 (16.7)
Gortex graft		1 (5.6)
Superior mesenteric vein resection	-	22 (68.8)	-
Reconstruction method	-		-
Primary anastomosis		18 (81.8)
Cadaveric vein graft		3 (13.6)
Gortex graft		1 (4.5)
Superior mesenteric artery resection	-	3 (9.4)	-
Reconstruction method	-		-
Primary anastomosis		3 (100)
Pancreaticojejunostomy construction method			0.358
Dunking	1 (2.2)	3 (9.4)
Duct to mucosa	43 (93.5)	28 (87.5)
Double loop	2 (4.3)	1 (3.1)
Size of pancreatic duct			0.239
< 2 mm	1 (2.4)	3 (13.0)
2-4 mm	15 (36.6)	8 (34.8)
< 4 mm	25 (61.0)	12 (52.2)
Pancreatic stent			0.882
No	32 (69.6)	21 (65.6)
Internal	3 (6.5)	3 (9.4)
External	11 (23.9)	8 (25.0)

Table 3 Short-term outcomes

Variables	Group 1	Group 2	P value
	(n= 46)	(n = 32)
Blood loss (mL)	800 (250-1600)	1200 (100-5000)	0.007
Operation time (min)	580 (378-855)	715 (487-992)	< 0.0001
Hospital stay (d)	17 (9-120)	17 (11-89)	0.316
Intensive care unit stay (d)	2 (1-10)	2 (0-24)	0.847
Hospital death	2 (4.3)	1 (3.1)	1.000
Patients with complication	20 (43.5)	10 (31.3)	0.275
Chest infection	3 (6.5)	2 (6.3)	1.000
Pleural effusion	1 (2.2)	1 (3.1)	1.000
Wound infection	7 (15.2)	1 (3.1)	0.176
Subphrenic abscess or collection	5 (10.9)	1 (3.1)	0.406
Intra-abdominal bleeding	1 (2.2)	0 (0.0)	1.000
Gastrointestinal bleeding	1 (2.2)	1 (3.1)	1.000
Cardiac arrhythmia	4 (8.7)	2 (6.3)	1.000
Acute coronary syndrome	2 (4.3)	1 (3.1)	1.000
Deep vein thrombosis	2 (4.3)	0 (0.0)	0.641
Delayed gastric emptying (> 7 d)	3 (6.5)	5 (15.6)	0.355
Types of pancreatic fistula according to ISGPF			0.662
All types	10 (21.7)	5 (15.6)
Type A	6 (13.0)	4 (12.5)
Type B	3 (6.5)	1 (3.13)
Type C	1 (2.2)	0 (0.0)

Data are expressed as median (range), or n (%). ISGPF: International Study Group on Pancreatic Fistula.

Table 4 Pathologic examination results

Variables	Group 1	Group 2	P value
	(n = 46)	(n = 32)
Tumor size (cm)	3 (1.0-8.0)	3 (1.6-6.0)	0.315
Lymph node metastases			0.299
No	21 (45.7)	12 (37.5)
< 5	22 (47.8)	15 (46.9)
5-10	2 (4.3)	5 (15.6)
> 10	1 (2.2)	0 (0.0)
Pancreaticojejunostomy construction method			0.613
Dunking or other	4 (12.5)	3 (6.5)
Duct to mucosa	28 (87.5)	43 (93.5)
R0 resection	35 (75.6)	25 (78.1)	0.793
R1 resection	11 (24.4)	7 (21.9)
AJCC staging (7th edition)			0.981
Stage IA	2 (4.3)	2 (6.3)
Stage IB	4 (8.7)	3 (9.4)
Stage IIA	14 (30.4)	8 (25.0)
Stage IIB	25 (54.3)	18 (56.3)
Stage III	1 (2.2)	1 (3.1)
Stage IA/IB/IIA (no lymph node involvement)	20 (43.5)	13 (40.6)	0.802
Stage IIB/III (advanced)	26 (56.5)	19 (59.4)

Data are expressed as median (range), or n (%). AJCC: American Joint Committee on Cancer.

Table 5 Univariate analyses of factors affecting survival outcomes

Factor	Median survival (mo)	P value
Median age (yr)		0.634
≤ 64 (n = 40)	22.35 ± 3.73
> 64 (n = 38)	15.84 ± 4.40
Sex		0.445
Male (n = 45)	22.35 ± 6.32
Female (n = 33)	19.26 ± 3.74
Comorbidity		0.890
No (n = 37)	20.05 ± 4.08
Yes (n = 41)	21.36 ± 4.34
Preoperative cholangitis		0.487
No (n = 76)	19.26 ± 3.54
Yes (n = 2)	21.36
Postoperative complication		0.204
No (n = 48)	23.79 ± 5.26
Yes (n = 30)	16.76 ± 4.18
International normalized ratio		0.924
≤ 1 (n = 55)	21.36 ± 2.79
> 1 (n = 15)	27.51 ± 14.53
Creatinine level (mmol/L)		0.652
≤ 79 (n = 37)	23.79 ± 4.42
> 79 (n = 36)	13.90 ± 2.98
Total bilirubin level ( mmol/L)		0.581
≤ 72 (n = 39)	22.35 ± 3.16
> 72 (n = 38)	16.66 ± 5.01
Serum albumin level (g/L)		0.419
≤ 40 (n = 44)	28.79 ± 8.12
> 40 (n = 29)	19.09 ± 3.77
Blood loss (mL)		0.284
≤ 850 (n = 36)	28.79 ± 5.84
> 850 (n = 33)	21.36 ± 4.89
Tumor Size (cm)		0.630
≤ 3 (n = 43)	16.76 ± 3.22
> 3 (n = 28)	19.09 ± 7.97
R1 resection		0.055
No (n = 59)	25.34 ± 5.32
Yes (n = 18)	13.44 ± 3.87
Lymph node metastases		0.113
No (n = 33)	28.79 ± 3.82
< 5 (n = 37)	17.12 ± 3.05
5-10 (n = 7)	11.40 ± 5.68
> 10 (n = 1)	22.18
Disease stage (AJCC staging, 7th edition)		0.036
Early (IA + IB + IC) (n = 33)	28.79 ± 5.00
Advanced (IIB + III + IV) (n = 45)	17.12 ± 3.41
Simultaneous vascular resection		0.815
Yes (n = 32)	21.36 ± 5.93
No (n = 46)	19.26 ± 3.58
Pancreatic fistula type (according to ISGPF)		0.488
No fistula + type A (n = 73)	20.05 ± 3.43
Type B + type C (n = 5)	13.90 ± 6.61

Data are presented as mean ± SE. AJCC: American Joint Committee on Cancer; ISGPF: International Study Group on Pancreatic Fistula.