Pancreas-sparing duodenectomy with regional lymph node dissection for early-stage ampullary carcinoma: A case control study using propensity scoring methods

Table 1 Patient characteristics between study groups

Characteristic	PD group	PSD group	P value
	(n = 69)	(n = 69)
Age (yr)	58.5 (41-79)	62.1 (39-78)	0.765
Gender, male, n (%)	36 (52.3)	38 (55.1)	0.681
Preoperative laboratory results
Hemoglobin (g/dL)	11.7 (9.0-14.3)	11.0 (9.3-14.5)	0.663
Total bilirubin (mg/dL)	7.1 (0.9-14.8)	7.6 (0.6-15.1)	0.701
Serum albumin (g/L)	3.5 (2.3-5.6)	3.7 (2.4-5.3)	0.913
CA19-9 (ng/mL)	33.8 (0.1-491)	37.1 (0.1-463)	0.594
CEA (ng/mL)	1.8 (0.1-30.2)	2.0 (0.1-31)	0.787
Past medical history, n (%)
Hypertension	21 (30.4)	23 (33.3)	0.604
Coronary artery disease	15 (21.7)	13 (18.8)	0.837
Diabetes mellitus	8 (11.6)	9 (13.0)	0.694
History of alcohol abuse	6 (8.7)	7 (10.1)	0.668
History of tobacco use	17 (24.6)	19 (27.5)	0.917
Myocardial infarction	5 (7.2)	4 (5.8)	0.857
Peripheral vascular disease	4 (5.8)	4 (5.8)	0.793
COPD	2 (2.9)	3 (4.3)	0.634

Data are expressed as number of patients or median (range). ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound; COPD: Chronic obstructive pulmonary disease; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; PD: Pancreaticoduodenectomy; PSD: Pancreas-sparing duodenectomy.

Table 2 Intra-operative characteristics between study groups

Characteristic	PD group	PSD group	P value
	(n = 69)	(n = 69)
Op. time (min)	481 (312-798)	435 (301-552)	0.048
Blood loss (mL)	802 (240-1900)	351 (150-1000)	0.031
Patients needing intraoperative blood transfusion, n (%)	23 (33.3)	7 (10.1)	0.027

Data are expressed as number of patients or median (range). Op. time: Operation time; PD: Pancreaticoduodenectomy; PSD: Pancreas-sparing duodenectomy.

Table 3 Postoperative characteristics between study groups

Characteristic	PD group	PSD group	P value
	(n = 69)	(n = 69)
Hospital stay (d), median (range)	18 (8-60)	10 (7-26)	0.045
ICU stay (d), median (range)	4 (2-15)	3 (1-7)	0.059
Hospital mortality, n (%)	3 (4.3)	2 (2.9)	0.081
Reoperation, n (%)	5 (7.2)	3 (4.3)	0.064
Postoperative complications, n (%)
Pancreatic leakage	16 (23.2)	3 (4.3)	0.037
Grade A	4	2	0.106
Grade B	8	0	0.058
Grade C	4	1	0.217
Delayed gastric emptying	15	6	0.045
New onset diabetes mellitus	8	0	0.041
Bile leak	2	0	0.678
Abdominal bleeding	9	5	0.721
Gastrointestinal bleeding	6	4	0.661
Wound infection	5	2	0.543
Sepsis	2	1	0.608
Abdominal abscess	4	2	0.334
Cardiac event	3	0	0.329

Data are expressed as number of patients or median (range). ICU: Intensive care unit; PD: Pancreaticoduodenectomy; PSD: Pancreas-sparing duodenectomy.

Table 4 Histopathological characteristics between study groups

Characteristic	PD group	PSD group	P value
	(n = 69)	(n = 69)
Tumor size (cm)	3.0 (1.5-5.0)	2.6 (0.6-4.7)	0.053
TNM classification: Primary tumor
Tis	4	3	0.071
T1	65	66	0.644
TNM classification: Regional lymph nodes, n
N0	45	49	0.339
N1	24	20	0.417
Number of positive nodes/evaluated nodes of JPS system, n (%)	22 (17.6)	18 (16.7)	0.402
JPS LN6	16/2	13/2	0.248
JPS LN8	10/0	8/0	0.375
JPS LN12	20/3	18/3	0.194
JPS LN13	39/10	34/8	0.527
JPS LN14	12/1	13/1	0.291
JPS LN17	28/6	22/4	0.396
Histopathologic types
Intestinal carcinoma	24	27	0.633
Pancreatobiliary carcinoma	42	40	0.597
Mixed type	3	2	0.304
Histologic grade
G1	32	34	0.312
G2	37	35	0.407
R0 resection, n	63	64	0.805
R1 resection, n	6	5	0.763

Data are expressed as number of patients or median (range). The Japan Pancreatic Society (JPS) system for numbering of lymph node stations: LN6, The infrapyloric node; LN8, The nodes around the anterior aspect of the common hepatic artery; LN12, The right-sided inferior nodes of the hepatoduodenal ligament; LN13, The posterior pancreatoduodenal nodes; LN14, The nodes around the superior mesenteric artery; LN17, The anterior pancreatoduodenal nodes; PD: Pancreaticoduodenectomy; PSD: Pancreas-sparing duodenectomy.

Table 5 Recurrence and survival between study groups

Characteristic	PD (n = 69)	PSD (n = 69)	P value
Recurrence rate, n (%)	14 (20.3)	16 (23.2)	0.427
Time to recurrence (mo)	10.2 (5.2-15.4)	8.7 (5.0-18.3)	0.518
Type of recurrence, n
Local recurrence	4	7	0.409
Distant metastases	4	6	0.331
Local recurrence and distant metastases	6	3	0.497
Overall survival
1 yr	81%	83%	0.617
3 yr	71%	70%	0.735
5 yr	46%	44%	0.591
Disease free survival
1 yr	81%	73%	0.704
3 yr	65%	61%	0.692
5 yr	41%	39%	0.679

Data are expressed as number of patients or median (range). PD: Pancreaticoduodenectomy; PSD: Pancreas-sparing duodenectomy.