Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy: A propensity score-matched study

Table 1 Comparisons of patients’ characteristics between the two groups

	Before PSM			After PSM
	Omental interposition group (127)	Non-omental interposition group (69)	P value	Omental interposition group (69)	Non-omental interposition group (69)	P value
Male/female	79/48	44/25	0.919	46/23	44/25	0.721
Age (yr)	64.8 ± 10.5	62.1 ± 9.9	0.083	64.2 ± 9.5	62.1 ± 9.9	0.210
BMI (mean ± SD, kg/m2)	21.9 ± 3.0	22.0 ± 2.8	0.844	21.9 ± 3.2	22.0 ± 2.9	0.933
ASA score, n (%)			0.126			0.168
I	65 (51.2)	42 (60.9)		34 (49.3)	42 (60.9)
II	60 (47.2)	24 (34.8)		34 (49.3)	24 (34.8)
III	2 (1.6)	3 (4.3)		1 (1.4)	3 (4.3)
Serum ALB [n (%), g/L]			0.152			1.00
< 35	13 (10.2)	12 (17.4)		12 (17.4)	12 (17.4)
≥ 35	114 (89.8)	57 (82.6)		57 (82.6)	57 (82.6)
Serum bilirubin (μmol/L)	96.5 (17.9-107.0)	20.5 (9.6-148.5)	0.015	29.8 (12.4-153.7)	20.5 (9.6-148.5)	0.753
Main pancreatic duct size [n (%), mm]			0.080			0.173
< 3	57 (44.9)	40 (58.0)		32 (46.4)	40 (58.0)
≥ 3	70 (55.1)	29 (42.0)		37 (53.6)	29 (42.0)
Operation method, n (%)			0.005			0.708
LPD	69 (54.3)	19 (27.5)		21 (30.4)	19 (27.5)
OPD	58 (45.7)	50 (72.5)		48 (69.6)	50 (72.5)
Pathology, n (%)			0.009			0.151
PDAC	53 (41.7)	25 (36.2)		36 (52.2)	25 (36.2)
Bile duct cancer	10 (7.9)	13 (18.8)		4 (5.8)	13 (18.8)
Ampulla of Vater cancer	18 (14.2)	15 (21.7)		10 (14.5)	15 (21.7)
Duodenal cancer	11 (8.7)	2 (2.9)		2 (2.9)	2 (2.9)
Other carcinoma	19 (15.0)	2 (2.9)		3 (4.3)	2 (2.9)
Benign tumor	16 (12.6)	12 (17.4)		14 (20.3)	12 (17.4)

ALB: Albumin; ASA: American Society of Anesthesiologist score; BMI: Body mass index LPD: Laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy.

Table 2 Comparisons of the postoperative outcomes between the two groups

	Before PSM			After PSM
	Omental interposition group (127)	Non-omental interposition group (69)	P value	Omental interposition group (69)	Non-omental interposition group (69)	P value
CR-POPF	13 (10.2%)	17 (24.6%)	0.028	7 (10.1%)	17 (24.6%)	0.025
Operation time (mean ± SD, min)	388.3 ± 68.8	365.2 ± 75.0	0.031	392.6 ± 74.1	365.2 ± 75.0	0.033
BF, n (%)	2 (1.6)	5 (7.2)	0.041	1 (1.4)	5 (7.2)	0.208
DGE, n (%)	4 (3.1)	6 (8.7)	0.178	1 (1.4)	6 (8.7)	0.115
PPH, n (%)	1 (0.8)	8 (11.6)	0.002	1 (1.4)	8 (11.6)	0.016
Intra-abdominal abscess, n (%)	15 (11.8)	12 (17.4)	0.286	8 (11.6)	12 (17.4)	0.333
Reoperation, n (%)	3 (2.4)	6 (8.7)	0.096	2 (2.9)	6 (8.7)	0.274
Mortality in 30 d, n (%)	2 (1.6)	5 (7.2)	0.101	2 (2.9)	5 (7.2)	0.438
Mortality related to POPF, n (%)	1 (0.8)	5 (7.2)	0.038	1 (1.4)	5 (7.2)	0.210
DFA1 around the HJ site (U/L)	300.0 (74.3-893.0)	599.8 (171.1-2064.7)	0.002	200.0 (57.5-659.8)	599.8 (171.1-2064.7)	0.003
DFA1 around the PJ site (U/L)	546.8 (76.4-3094.0)	350.0 (50.0-2577.4)	0.255	325.0 (69.5-2972.5)	350.0 (50.0-2577.4)	0.951
Duration until removal of the tube around the HJ site (d)	7 (5-9)	9 (7-14)	0.000	8 (6-11)	9 (7-14)	0.115
Duration until removing the tube around the PJ site (d)	7 (6-11)	10 (7-15)	0.004	8 (6-12)	10 (7-15)	0.100
Required blood transfusions, n (%)	18 (14.2)	20 (29.0)	0.012	9 (13.0)	20 (29.0)	0.022
Length of hospital stay (d)	15 (11-22)	21 (13-32)	0.004	16 (12-24)	21 (13-32)	0.031
Duration until restarting diet (d)	6 (5-8)	8 (6-15)	0.001	7 (5-8)	8 (6-15)	0.048

BF: Biliary fistula; CR-POPF: Clinically relevant postoperative pancreatic fistula; DFA1: Drain fluid amylase obtained on the first postoperative day; DGE: Delayed gastric emptying; HJ: Hepaticojejunostomy; PJ: Pancreaticojejunostomy; PPH: Postpancreatectomy hemorrhage.

Table 3 The univariate and multivariate analyses of the propensity score-matched data to evaluate the risk factors associated with clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy

	CR-POPF (24)	No CR-POPF (114)	P value	Multivariate analysis
				OR	95%CI	P value
Age (mean ± SD, yr)	63.5 ± 7.9	63.1 ± 10.1	0.829
Sex, n (%)			0.040
Male	20 (83.3%)	70 (61.4%)		2.436	0.692-8.574	0.165
Female	4 (16.7%)	44 (38.6%)		Reference
Operation method, n (%)			0.143
LPD	4 (16.7%)	36 (31.6%)
OPD	20 (83.3%)	78 (68.4%)
BMI (kg/m2)			0.000
≥ 23	18 (75.0%)	33 (28.9%)		6.094	2.021-18.374	0.001
< 23	6 (25.0%)	81 (71.1%)		Reference
Serum bilirubin (μmol/L)	96.6 (16.1-180.4)	67 (13.8-111.2)	0.185
Serum ALB (g/L)			0.843
≥ 35	21 (87.5%)	98 (86.0%)
< 35	3 (12.5%)	16 (14.0%)
ASA score, n (%)			0.122
Grade I	11 (45.8%)	66 (57.9%)
Grade II	11 (45.8%)	47 (41.2%)
Grade III	2 (8.3%)	1 (0.9%)
Pathology, n (%)			0.196
Malignancy	23 (95.8%)	96 (84.2%)
Benign	1 (4.2%)	18 (15.8%)
Omental interposition, n (%)			0.025
Yes	7 (29.2%)	62 (54.4%)		Reference
No	17 (70.8%)	52 (45.6%)		3.145	1.040-9.509	0.042
Operating time (mean ± SD, min)	387.1±82.5	377.7±71.2	0.609
HJ DFA1 (U/L)			0.010
≥ 1000	13 (54.2%)	31 (27.2%)		1.000	1.000-1.000	0.834
< 1000	11 (45.8%)	83 (72.8%)		Reference
PJ DFA1 (U/L)			0.115
≥ 1000	13 (54.2%)	42 (36.8%)
< 1000	11 (45.8%)	72 (63.2%)
Main pancreatic duct size [n (%), mm]			0.000
≥ 3	3 (12.5%)	64 (56.1%)		Reference
< 3	21 (87.5%)	50 (43.9%)		5.663	1.456-22.033	0.012

ALB: Albumin; ASA: American Society of Anesthesiologist score; BMI: Body mass index; DFA1: Drain fluid amylase obtained on the first postoperative day; HJ: Hepaticojejunostomy; LPD: Laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy; PJ: Pancreaticojejunostomy.