Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

Table 1 Demographic and clinical characteristics of 291 patients

	Blumgart anastomosis	Embedded anastomosis	P-value
No. of patients	201	90
Age, mean ± SE, yr	53.28 ± 1.35	54.54 ± 1.81	0.584
Sex (male/female)	109/92	41/49	0.172
Past medical history, n (%)
Diabetes mellitus	40 (19.9)	20 (22.2)	0.652
Cholecystolithiasis	39 (19.4)	20 (22.2)	0.582
Cardiovascular disease	50 (24.9)	28 (31.1)	0.269
Personal medical history, n (%)
Smoking	97 (48.3)	50 (55.6)	0.251
Drinking	53 (26.4)	25 (27.8)	0.803
Preoperative lab test, mean ± SE
Serum albumin, g/L	41.82 ± 1.54	40.50 ± 1.41	0.552
Total bilirubin, μmol/L	69.53 ± 13.8	54.87 ± 15.1	0.510
Direct bilirubin, μmol/L	49.66 ± 11.0	41.53 ± 13.0	0.653
Cancer antigen 19-9, U/L	239.6 ± 41.9	248.5 ± 53.9	0.896
Diameter of the mass, mean ± SE, cm	3.46 ± 0.23	3.06 ± 0.29	0.314
Type of neoplasms, n (%)
Pancreatic ductal adenocarcinoma	137 (68.2)	65 (72.2)	0.489
Intraductal papillary mucinous neoplasm	6 (3.0)	2 (2.2)	0.714
Cystic lesion	10 (4.9)	4 (4.4)	0.846
Neuroendocrine tumor	6 (3.0)	3 (3.3)	0.875
Solid-pseudopapillary tumor	13 (6.5)	6 (6.7)	0.950
Pancreatitis	10 (4.9)	5 (5.6)	0.837
Others	19 (9.5)	5 (5.6)	0.266

Table 2 Intraoperative and perioperative statuses

		Blumgart anastomosis	Embedded anastomosis	P-value
Intraoperative results, n (%)
No. of patients		201	90
Operation time, mean ± SEM, min		343.5 ± 23.0	450.0 ± 40.1	0.028
Blood loss, mean ± SE, mL		641.4 ± 65.9	866.7 ± 102	0.073
Blood transfusion, n (%)		76 (37.8)	44 (48.9)	0.077
Diameter of the pancreatic duct, mean ± SE, mm		5.50 ± 0.79	4.85 ± 0.15	0.687
Insertion of pancreatic duct stent, n (%)		96 (47.8)	33 (36.7)	0.079
Texture of the pancreas	Soft	33 (16.4)	15 (16.7)	0.958
	Tough	117 (58.2)	45 (50.0)	0.194
	Hard	51 (25.4)	30 (33.3)	0.163
Postoperative results, n (%)
Mortality		1 (0.5)	1 (1.1)	0.560
Reoperation		12 (6.0)	11 (12.2)	0.068
Overall complications (≥Clavien grade 3)		24 (11.9)	24 (26.7)	0.002
Duration of PJ drainage tube placement, mean ± SE, d		12.7 ± 0.9	17.4 ± 1.8	0.031
Postoperative pancreatic fistula	None	105 (52.2)	40 (44.4)	0.220
	Biochemical leak	77 (38.3)	31 (34.4)	0.530
	Grade B	16 (8.0)	14 (15.6)	0.049
	Grade C	3 (1.5)	5 (5.6)	0.050
Abdominal bleeding		14 (7.0)	11 (12.2)	0.140
Intraperitoneal infections		12 (6.0)	7 (7.8)	0.566
Biliary fistula		5 (2.5)	4 (4.4)	0.375
Delayed gastric emptying (≥ISGPS grade B)		34 (16.9)	20 (22.2)	0.284
Others		21 (10.5)	12 (13.3)	0.475
Postoperative hospitalization duration, mean ± SE, d		21.9 ± 1.3	28.9 ± 1.3	0.020

PJ: Pancreaticojejunostomy; ISGPS: International Study Group of Pancreatic Surgery. Others: Thromboembolism, aortic dissection, anastomotic fistula, etc.

Table 3 Information of the patients with postoperative pancreatic fistula

	POPF (<ISGPS grade B)	POPF (≥ISGPS grade B)	P-value
No. of patients	253	38
Age, mean ± SE, yr	53.30 ± 1.16	54.79 ± 3.22	0.640
Sex (male/female)	131/122	19/19	0.839
Body mass index, mean ± SE, kg/m2	23.13 ± 0.40	23.84 ± 0.87	0.486
Blumgart anastomosis, n (%)	182 (71.9)	19 (50.0)	0.006
Hard pancreas, n (%)	75 (29.7)	6 (15.8)	0.076
Pancreatic malignancy, n (%)	179 (70.8)	23 (60.5)	0.204
Pancreatitis, n (%)	14 (5.5)	1 (2.6)	0.452
Diameter of the pancreatic duct, mean ± SE, mm	5.42 ± 0.35	4.65 ± 0.30	0.131
Intraoperative blood loss, mean ± SE, mL	681.6 ± 70.8	819.1 ± 140	0.347

POPF: Postoperative pancreatic fistula; ISGPS: International Study Group of Pancreatic Surgery.