Comparison of prognosis and postoperative morbidities between standard pancreaticoduodenectomy and the TRIANGLE technique for resectable pancreatic ductal adenocarcinoma

Table 1 Characteristics of the 93 pancreatic ductal adenocarcinoma patients

Characteristics	PDstandard group	PDTRIANGLE group	P value
	(n = 56)	(n = 37)
Age (yr)	65.7 ± 10.1	64.2 ± 10.8	0.503
Sex (M/F)	33/23	17/20	0.219
BMI (kg/m2)	23.1 ± 3.3	23.8 ± 2.9	0.250
NRS2002 score, median (IQR)	4 (3-5)	4 (3-5)	0.888
Jaundice, n (%)	23 (41.1)	20 (54.1)	0.219
Preoperative biliary drainage, n (%)	12 (21.4)	9 (24.3)	0.744
Tumor size (cm)	2.6 ± 0.8	2.5 ± 1.1	0.604
CA19-9 (U/mL), median (IQR)	141.0 (25.4-370.5)	112.6 (16.8-355.9)	0.580
Albumin (g/L)	38.4 ± 3.1	39.2 ± 2.8	0.267
Hb (g/L)	122.6 ± 14.9	127.4 ± 12.1	0.110

BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; Hb: Hemoglobin; IQR: Interquartile range; NRS2002: Nutrition risk screening 2002 score; PD: Pancreaticoduodenectomy.

Table 2 Comparison of surgical data and postoperative morbidities between PD_standard group and PD_TRIANGLE group

Variables	PDstandard group	PDTRIANGLE group	P value
	(n = 56)	(n = 37)
Surgical data
Duration of operation (min), median (IQR)	320 (265-427)	440 (410-480)	0.0011
Intraoperative blood loss (mL), median (IQR)	500 (300-800)	700 (500-1200)	0.0091
Volume of blood transfusion (mL), median (IQR)	400 (0-800)	975 (0-1250)	0.0091
Number of complications, n (%)			0.0071
CDC II	32 (57.1)	22 (59.4)
CDC IIIa	3 (5.4)	3 (8.1)
CDC IIIb	0 (0)	4 (10.8)
CDC Ⅳa	0 (0)	1 (2.7)
POPF, n (%)	19 (17.8)	7 (18.9)	0.114
CR-POPF, n (%)	9 (16.1)	5 (13.5)	0.736
Bile leakage, n (%)	6 (10.7)	2 (5.4)	0.470
DGE, n (%)	12 (21.4)	4 (10.8)	0.263
SSI, n (%)	7 (12.5)	16 (43.2)	0.0011
PPH, n (%)	6 (10.7)	1 (2.7)	0.237
Chyme leakage, n (%)	5 (8.9)	5 (13.5)	0.485
Postoperative diarrhea, n (%)	7 (12.5)	20 (54.1)	0.0011
Postoperative length of stay (d)	18 (14-24)	18 (14-25)	0.765

¹Significant P value.

CDC: Clavien-Dindo classification; POPF: Postoperative pancreatic fistula; CR-POPF: Clinically relevant postoperative pancreatic fistula; DGE: Delayed gastric emptying; IQR: Interquartile range; PPH: Post-pancreatectomy hemorrhage; PD: pancreaticoduodenectomy; SSI: Surgical site infection.

Table 3 Comparison of short-term oncological outcomes between PD_standard group and PD_TRIANGLE group, n (%)

Variables	PDstandard group	PDTRIANGLE group	P value
	(n = 56)	(n = 37)
T stage			0.600
1	9 (16.1)	6 (16.2)
2	40 (71.4)	24 (64.7)
3	7 (12.5)	7 (18.9)
4	0 (0)	0 (0)
N stage			0.581
0	29 (51.7)	18 (48.7)
1	14 (25.0)	17 (45.9)
2	13 (23.3)	2 (5.4)
M stage			1.000
0	55 (98.3)	36 (97.3)
1	1 (1.7)	1 (2.7)
TNM stage			0.341
Ⅰ	24 (42.8)	17 (45.9)
II	19 (33.9)	17 (45.9)
III	10 (17.8)	2 (5.4)
IV	3 (5.5)	1 (2.7)
Tumor differentiation			0.752
Poor	21 (37.5)	17 (45.9)
Moderate	35 (62.5)	17 (45.9)
Well	0 (0)	3 (8.2)
Resection margin status			0.453
R0	40 (71.4)	29 (78.3)
R1	16 (28.6)	8 (21.7)
No. of examined lymph nodes	14 (9-20)	19 (13-24)	0.0101

¹Significant P value.

T: Tumor; N: Node; M: Metastasis; PD: Pancreaticoduodenectomy.

Table 4 Comparison of long-term oncological outcomes between PD_standard group and PD_TRIANGLE group

Variables	PDstandard group	PDTRIANGLE group	P value
	(n = 56)	(n = 37)
Tumor recurrence, n (%)	27 (48.2)	14 (37.8)	0.324
Local recurrence, n (%)	12 (21.4)	4 (10.8)	0.263
Follow-up duration (months)
Median	33	21	0.052
IQR	10.0-54.0	9.0-51.0
Adjuvant treatment, n (%)	47 (83.9)	29 (78.4)	0.654

IQR: Interquartile range; PD: Pancreaticoduodenectomy.