Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: A retrospective cohort study

Table 1 Clinical characteristics of the patients, n (%)

Variables	Total patients, n = 215
Gender (male/female)	112/103
Age (yr)	54.5 ± 13.3
Diabetes mellitus	51 (23.7)
Smoking history	92 (42.8)
History of abdominal operation	48 (22.3)
Preoperative total bilirubin (µmol/L)	186.9 ± 74.4
Preoperative biliary drainage	123 (57.2)
Albumin (g/L)	35.4 ± 4.8
Pathological types
Ampullary carcinoma	102 (47.4)
Pancreatic head carcinoma	51 (23.7)
Distal cholangiocarcinoma	35 (16.3)
Duodenal papillary carcinoma	22 (10.2)
Ampullary benign diseases	2 (0.9)
Other rare diseases	3 (1.4)
Anastomotic method
End-to-side invagination pancreatoduodenectomy	108 (50.2)
Modified duct-to-mucosa pancreatoduodenectomy	107 (47.8)
Main pancreatic duct diameter
≤ 3 mm	121 (56.3)
> 3 mm	94 (43.7)
Pancreatic texture
Hard	112 (52.1)
Soft	103 (47.9)
Postoperative complications
Postoperative pancreatic fistula	42 (19.5)
Grade A	27 (12.6)
Grade B	11 (5.1)
Grade C	4 (1.9)
Operative time (min)	308.4 ± 57.3
Blood loss (mL)	555.1 ± 228.7
Peritoneal infection	28 (13)
Intra-abdominal hemorrhage	25 (11.6)
Biliary fistula	20 (9.3)
Re-operation	4 (1.9)
Mortality	2 (0.9)
Length of stay (d)	15.7 ± 2.7

Table 2 Univariate and Multivariate logistic regression analysis of risk factors associated with postoperative pancreatic fistula

	Univariate		Multivariate
	OR (95%CI)	P value	OR (95%CI)	P value
Age (≤ 60 vs > 60 yr)	1.603 (0.800-3.203)	0.188
Gender (male vs female)	1.143 (0.594-2.266)	0.7
Diabetes mellitus	0.711 (0.324-1.585)	0.427
Smoking history	1.275 (0.649-2.470)	0.481
History of abdominal operation	0.782 (0.355-1.757)	0.57
Preoperative total bilirubin (≤ 171 vs > 171 µmol/L)	1.295 (0.654-2.700)	0.475
Preoperative biliary drainage (yes vs no)	1.444 (0.740-2.894)	0.385
Serum albumin (≤ 35 vs > 35 g/L)	0.665 (0.322-1.359)	0.275
Anastomotic method (End-to-side invagination pancreaticojejunostomy vs Modified duct-to-mucosa pancreaticojejunostomy)	3.045 (1.500-6.248)	0.002a	0.288 (0.129-0.606)	0.0015a
Main pancreatic duct diameter (≤ 3 vs > 3 mm)	2.599 (1.255-5.676)	0.011a	3.608 (1.678-8.302)	0.0015a
Operative time (≤ 300 vs > 300 min)	1.125 (0.583-2.181)	0.735
Blood loss (≤ 600 vs > 600 mL)	0.855 (0.431-1.645)	0.651
Pancreatic texture (Hard vs Soft)	0.494 (0.253-0.956)	0.043a	2.171 (1.051-4.602)	0.0386a

^aStatistically significant.

Table 3 Comparison results between End-to-side invagination pancreatoduodenectomy and Modified duct-to-mucosa pancreatoduodenectomy, n (%)

	End-to-side invagination pancreatoduodenectomy (n = 108)	Modified duct-to-mucosa pancreatoduodenectomy (n = 107)	P value
Age (yr)	53.6 ± 13.7	55.3 ± 12.8	0.336
Male	50 (46.3)	62 (57.9)	0.088
Pancreatic texture			0.152
Hard	51 (47.2)	61 (57.0)
Soft	57 (52.8)	46 (43.0)
Main pancreatic duct diameter			0.033a
≤ 3 mm	53 (49.1)	68 (63.6)
> 3 mm	55 (50.9)	39 (36.4)
Operative time (min)	333.2 ± 48.9	283.4 ± 54.2	< 0.0001a
Blood loss (mL)	571.4 ± 257.3	538.7 ± 195.4	0.295
Postoperative complications
Postoperative pancreatic fistula	30 (27.8)	12 (11.2)	0.002a
Grade A	20 (18.5)	7 (15.9)
Grade B	7 (6.5)	4 (3.7)
Grade C	3 (2.8)	1 (0.9)
Peritoneal infection	13 (12.0)	15 (13.9)	0.38
Intra-abdominal hemorrhage	15 (13.9)	10 (9.3)	0.299
Biliary fistula	11 (10.2)	9 (8.3)	0.654
Re-operation	3 (2.8)	1 (0.9)	0.622
Mortality	2 (1.9)	0 (0)	0.498
Length of stay (d)	16 ± 2.6	15.5 ± 2.8	0.187

^aStatistically significant.