Table 1 shows the clinical characteristics and surgical details of the patients. All patients were Japanese, and there were more females (n = 34, 57.6%) than males (n = 25, 42.4%). The median age of the patients was 68.9 years. Pancreatic cancer was the primary cause of death (50.8%). The mean operative time was 194.5 minutes, and the mean blood loss was 125.6 mL. Lap-DP was performed in 52 patients (88.1%), and the spleen was preserved in 7 patients (11.9%). In addition, 9 patients (15.3%) had Grade B POPFs. None of the patients died or developed Grade C POPFs. The median number of days to drain removal was 13.3 days, and the mean hospital stay was 9.4 days.
Table 1
Clinical and surgical factors of the study group
Factor | Patients (n = 59) |
Age, mean (SD), years | 68.9 (13.0) |
Sex (male:female) | 25:34 |
BMI, mean (SD) | 22.8 (5.0) |
Thickness of pancreas, mean (SD), mm | 13.9 (5.2) |
Pancreatic texture (hard:soft) | 12:47 |
Diagnosis | |
Pancreatic cancer | 30 (50.8%) |
IPMC | 9 (15.3%) |
IPMA | 5 (8.8%) |
NET | 5 (8.8%) |
SCN | 4 (6.8%) |
MCN | 3 (5.1%) |
SPN | 3 (5.1%) |
Surgical procedure | |
Lap-DP | 52 (88.1%) |
Lap–spleen-preserving DP | 7 (11.9%) |
Operation time, mean (SD), min | 194.5 (50.5) |
Blood loss, mean (SD), mL | 125.6 (135.4) |
ISGPF POPF ≥ Grade B | 9 (15.3%) |
Mortality | 0 |
Days drain removed, mean (SD) | 13.3 (27.3) |
Hospital stay, mean (SD) | 9.4 (4.1) |
BMI, body mass index; IPMC, intraductal papillary mucinous carcinoma; IPMA, intraductal papillary mucinous adenoma; NET, neuroendocrine tumor; SCN, serous cystic neoplasm; MCN, mucinous cystic neoplasm; SPN, solid pseudopapillary neoplasm; Lap-DP, laparoscopic distal pancreatectomy; SD, standard deviation; ISGPF, International Study Group of Pancreatic Fistula; POPF, postoperative pancreatic fistula
Table 2 presents the characteristics of the slow-compression and no-compression groups. Sex, BMI, pancreatic thickness at the pancreatic dissection site, pancreatic texture, and diagnoses were not significantly different between the two groups. However, univariate analysis showed that the operative time (218.7 min vs 183.0 min, p = 0.004), blood loss (165.8 ml vs 106.5 ml, p = 0.047), postoperative pancreatic fluid leakage (31.6% vs 7.5%, p = 0.017), day of drain removal (23.2 days vs 8.5 days, p ≦ 0.001), and hospital stay (11.1 days vs 8.6 days, p = 0.006) were lower in the no-compression group than in the slow-compression group. The no-compression group was older than the slow-compression group (63.5 vs 71.5 years, p = 0.003).
Table 2
Comparison of different pancreatic dissection methods
| Slow-compression (n = 19) | No-compression (n = 40) | Univariate analysis |
Age, mean (SD), years | 63.5 (11.2) | 71.5 (13.3) | 0.003 |
Sex (male:female) | 6:13 | 19:21 | 0.248 |
BMI, mean (SD) | 23.2 (4.4) | 22.2 (5.3) | 0.109 |
Thickness of pancreas, mean (SD), mm | 15.0 (5.0) | 13.4 (5.1) | 0.446 |
Pancreatic texture (hard/soft) | 4/15 | 8/32 | 0.871 |
Diagnosis | | | |
Pancreatic cancer | 9 | 21 | |
IPMC | 3 | 6 | |
IPMA | 0 | 5 | |
NET | 2 | 3 | |
SCN | 3 | 1 | |
MCN | 1 | 2 | |
SPN | 2 | 1 | |
Surgical procedure | | | |
Lap-DP | 16 | 36 | |
Lap–spleen-preserving DP | 3 | 4 | |
Operation time, mean (SD), min | 218.7 (48.6) | 183.0 (48.4) | 0.004 |
Blood loss, mean (SD), mL | 165.8 (154.4) | 106.5 (122.9) | 0.047 |
ISGPF POPF ≥ Grade B | 6 (31.6%) | 3 (7.5%) | 0.017 |
Days drain removed, mean (SD) | 23.2 (39.9) | 8.5 (15.5) | 0.001 |
Hospital stay, mean (SD) | 11.1 (3.8) | 8.6 (4.1) | 0.006 |
BMI, body mass index; IPMC, intraductal papillary mucinous carcinoma; IPMA, intraductal papillary mucinous adenoma; NET, neuroendocrine tumor; MCN, mucinous cystic neoplasm; SPN, solid pseudopapillary neoplasm; SCN, serous cystic neoplasm; Lap-DP, laparoscopic distal pancreatectomy; SD, standard deviation; ISGPF, International Study Group of Pancreatic Fistula; POPF, postoperative pancreatic fistula; NS, not significant
Characteristics were also compared between patients with and without POPF (POPF and no-POPF groups, respectively) (Table 3). In the univariate analysis, sex and BMI were not significantly different between the two groups. There were also no significant differences in the thickness of the pancreas at the dissection level, pancreatic texture, operative time, or intraoperative blood loss. However, the number of days until drain removal (58 days vs 5.1 days, p < 0.001) and hospital stay (14.4 days vs 8.5 days, p < 0.001) was significantly shorter in the no-POPF group and significantly longer in the no-compression group (p = 0.017). The median age was higher in the no-POPF group than in the POPF group (59.3 vs 70.7, p = 0.016).
Table 3
Comparison between POPF and no-POPF groups
| POPF (n = 9) | No POPF (n = 50) | Univariate analysis |
Age, mean (SD), years | 59.3 (13.9) | 70.7 (12.3) | 0.016 |
Sex (male:female) | 4:5 | 21:29 | 0.891 |
BMI, mean (SD) | 23.4 (2.9) | 22.4 (5.3) | 0.199 |
Thickness of pancreas, mean (SD), mm | 15.9 (3.5) | 13.6 (5.3) | 0.15 |
Pancreatic texture (hard/soft) | 3/6 | 9/41 | 0.621 |
Diagnosis | | | |
Pancreatic cancer | 3 | 27 | |
IPMC | 2 | 7 | |
IPMA | 0 | 5 | |
NET | 0 | 5 | |
SCN | 1 | 3 | |
MCN | 2 | 1 | |
SPN | 1 | 2 | |
Surgical procedure | | | |
Lap-DP | 7 | 45 | |
Lap–spleen-preserving DP | 2 | 5 | |
Operation time, mean (SD), min | 195.7 (47.6) | 194.3 (52.0) | 0.933 |
Blood loss, mean (SD), mL | 186.3 (187.8) | 114.6 (123.0) | 0.217 |
Drain removed, mean (SD) | 58 (48.1) | 5.1 (3.8) | 0.001 |
Hospital stay, mean (SD) | 14.4 (3.43) | 8.5 (3.57) | 0.001 |
No compression/slow compression | 3/6 | 37/13 | 0.017 |
BMI: body mass index, IPMC: intraductal papillary mucinous carcinoma, IPMA: intraductal papillary mucinous adenoma, NET: neuroendocrine tumor, MCN: mucinous cystic neoplasm, SPN: solid pseudopapillary neoplasm, SCN: serous cystic neoplasm, Lap-DP: laparoscopic distal pancreatectomy, SD: standard deviation |
In the multivariate analysis, the absence of POPF was significantly more frequent in the no-compression group (OR, 5.69; 95% CI, 1.241–26.109, p = 0.025). Furthermore, older age was a risk factor for pancreatic leakage (OR, 0.944; 95% CI, 0.897–0.993, p = 0.026) (Table 4).
Table 4
Risk factors of clinical pancreatic fistula
| Odd ratio | 95% Confidence interval | p-value |
Age | 0.944 | 0.897–0.993 | 0.026 |
Thickness of pancreas | | | NS |
Blood loss | | | NS |
No compression/slow compression | 5.69 | 1.241–26.109 | 0.025 |