Identifying the risk factors for pancreatic fistula after laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer

Table 1 Comparison of general data between the two groups [mean ± SD, n (%)]

Profile	PF group (n = 15)	Non-PF group (n = 186)	t/χ2/z value	P value
Sex			5.227	0.022
Male	13 (86.67)	105 (56.45)
Female	2 (13.33)	81 (43.55)
Age (yr)	66.00 ± 8.64	62.35 ± 9.19	1.486	0.139
BMI (kg/m²)	24.17 ± 2.96	22.58 ± 2.43	2.404	0.017
Smoking history			0.408	0.523
Yes	3 (20.00)	26 (13.98)
No	12 (80.00)	160 (86.02)
Hypertension			6.209	0.013
Yes	10 (66.67)	64 (34.41)
No	5 (33.33)	122 (65.59)
Combined diabetes			0.053	0.818
Yes	3 (20.00)	42 (22.58)
No	12 (80.00)	144 (77.42)
ASA classification			0.849	0.654
Level 1	0	7 (3.76)
Level 2	15 (100)	176 (94.62)
Level 3	0	3 (1.62)

BMI: Body mass index; PF: Pancreatic fistula; ASA: American Society of Anesthesiologists.

Table 2 Comparison of preoperative laboratory indicators between the two groups [mean ± SD, M (P25, P75), n (%)]

Laboratory index	PF group (n = 15)	Non-PF group (n = 186)	t/χ2/z value	P value
Hemoglobin (g/L)	129.93 ± 19.42	127.24 ± 16.18	0.610	0.542
PLT (× 109/L)	229.00 (197.00, 293.00)	233.00 (194.75, 289.00)	-0.113	0.910
NEUT (× 109/L)	4.70 (2.40, 5.60)	4.10 (2.90, 5.30)	-0.552	0.581
Monocyte count (× 109/L)	0.50 (0.40, 0.70)	0.50 (0.40, 0.53)	-2.020	0.043
Lymphocyte count (× 109/L)	1.60 (1.10, 1.70)	1.50 (1.20, 1.90)	-0.125	0.901
ALB (g/L)	41.57 ± 3.95	43.29 ± 4.08	-1.579	0.116
TBIL (μmol/L)	14.10 (7.90, 87.20)	27.50 (11.20, 103.15)	-1.199	0.231
Carbohydrate antigen (CA199)			2.197	0.138
≥ 35 U/mL	14 (93.33)	143 (76.88)
< 35 U/mL	1 (6.67)	43 (23.12)
Carbohydrate antigen (CA125, U/mL)	17.30 (11.50, 24.40)	15.80 (10.80, 24.20)	-0.198	0.843
AFP (ng/mL)	3.38 (2.23, 3.79)	2.87 (2.16, 3.83)	-0.443	0.658
CEA (ng/mL)	2.28 (2.01, 3.83)	3.26 (2.03, 5.32)	-1.317	0.188

PLT: Platelet count; NEUT: Neutrophil count; ALB: Albumin; TBIL: Total bilirubin; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen; PF: Pancreatic fistula.

Table 3 Comparison of operation-related indicators between the two groups [mean ± SD, M (P25, P75), n (%)]

Operation-related index	PF group (n = 15)	Non-PF group (n = 186)	t/χ2/z value	P value
Pancreatic texture			64.728	< 0.001
Soft	11 (93.33)	11 (5.91)
Hard	4 (6.67)	175 (94.09)
Pancreatic duct diameter			7.807	0.005
> 3 mm	5 (33.33)	128 (68.82)
≤ 3 mm	10 (66.67)	58 (31.18)
Intraoperative blood loss (mL)	200.00 (200.00, 300.00)	200.00 (100.00, 300.00)	-1.939	0.052
Operation time (min)	439.87 ± 51.184	382.94 ± 61.74	3.474	0.001
Am			17.323	< 0.001
> 1069 U/L	12 (80.00)	52 (27.96)
≤ 1069 U/L	3 (20.00)	134 (72.04)

Am: Amylase; PF: Pancreatic fistula.

Table 4 Variable assignment

Variable	Variable name	Assignment description
Pancreatic fistula in patients with pancreatic cancer after LPD	Y	Yes = 1
		No = 0
Sex	X1	Male = 1
		Female = 0
BMI	X2	> 24.91 kg/m² = 1
		≤ 24.91 kg/m² = 0
Hypertension	X3	Yes = 1
		No = 0
Monocyte count	X4	> 0.4 × 109/L = 1
		≤ 0.4 × 109/L = 0
Pancreatic texture	X5	Soft = 1
		Hard = 0
Pancreatic duct diameter	X6	> 3 mm = 1
		≤ 3mm = 0
Operation time	X7	> 414 min = 1
		≤ 414 min = 0
Am		> 1069 U/L = 1
		≤ 1069 U/L = 0

BMI: Body mass index; Am: Amylase.

Table 5 Results of logistic regression analysis of multiple factors influencing pancreatic fistula in patients with pancreatic cancer after laparoscopic pancreaticoduodenectomy

Variable	B value	SE value	Wald value	P value	OR	95%CI
Sex	1.086	1.039	1.091	0.296	2.961	0.386-22.71
BMI (kg/m²)	2.637	1.022	6.661	0.010	13.978	1.886-103.581
Hypertension	2.138	0.989	4.67	0.031	8.484	1.22-58.994
monocyte count (× 109/L)	1.591	1.135	1.966	0.161	4.909	0.531-45.372
Pancreatic texture	3.738	1.019	13.448	< 0.001	42.015	5.698-309.782
Pancreatic duct diameter	-0.755	1.122	0.452	0.501	0.470	0.052-4.244
Operation time (min)	2.735	1.146	5.694	0.017	15.41	1.63-145.674
Am (U/L)	1.662	1.056	2.476	0.116	5.268	0.665-41.734

BMI: Body mass index; Am: Amylase.

Table 6 Receiver operating characteristic curve analysis of influencing factors predicting pancreatic fistula after laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer

Factor	AUC	Sensitivity	Specificity	95%CI	P value
BMI (kg/m²)	0.655	0.467	0.844	0.496-0.815	0.045
Hypertension	0.661	0.667	0.656	0.518-0.805	0.038
Pancreatic texture	0.837	0.733	0.941	0.702-0.972	< 0.001
Operation time (min)	0.758	0.800	0.715	0.634-0.881	0.001

AUC: Area under the curve; BMI: Body mass index; CI: Confidence interval.