Case Control Study
Copyright ©The Author(s) 2025.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 104652
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.104652
Table 1 The preoperative characteristics of patients in the three groups who underwent pancreaticoduodenectomy, n (%)
Characteristics
EDS group (n = 129)
IDS group (n = 71)
NDS group (n = 44)
P value
Age, years68 (45-86)64 (17-85)66 (16-89)0.091
Sex, male/female65/64 (50.4/ 49.6)43/28 (60.6/39.4)24/20 (54.5/45.5)0.384
ASA score0.652
I-II62 (48.1)38 (53.6)22 (50)
III-IV67 (51.9)33 (46.4)22 (50)
Body mass index, kg/m224.6 (16-41)25.2 (14-43.3)24.5 (18-36.3)0.760
Comorbidities
Cardiovascular68 (52.7)32 (45.1)22 (50)0.124
Hypertension59 (45.7)31 (43.7)16 (36.4)0.556
Smoker28 (21.7)17 (23.9)8 (18.2)0.887
Diabetes27 (20.9)23 (32.4)14 (31.8)0.109
Pulmonary24 (18.6)18 (25.3)8 (18.2)0.096
Tumor19 (14.7)9 (12.7)8 (18.2)0.549
Alcohol use18 (14)10 (14.1)4 (9.1)0.886
Neoadjuvant chemotherapy19 (14.7)7 (9.9)2 (4.5)0.165
Clinical
Jaundice84 (65.1)42 (59.2)24 (54.5)0.412
Weight loss72 (55.8)
Abdominal pain62 (48.1)25 (35.2)18 (40.9)0.204
Cholangitis24 (18.6)13 (18.3)8 (18.2)0.997
Preoperative pancreatitis10 (7.8)6 (8.5)12 (27.3)0.001
Duodenal obstruction9 (7)4 (5.6)0 (0)0.203
Upper gastrointestinal bleeding8 (6.2)3 (4.2)2 (4.5)0.811
Diagnostic examinations/findings
CT scan126 (97.7)69 (97.2)43 (97.7)0.973
MRI91 (70.5)53 (74.6)30 (68.2)0.728
Endoscopic ultrasound73 (56.6)49 (69)27 (61.4)0.226
ERCP64 (49.6)38 (53.5)23 (52.3)0.886
PTHC19 (14.7)8 (11.3)3 (6.8)0.368
Tumor size, cm2.2 (0.1-6)2.1 (0.2-7.1)2 (0.2-5.5)0.653
Bile duct size, cm1.2 (0.3-2.5)1.2 (0.2-2.4)1 (0.2-3.1)0.303
Preoperative biliary stent0.127
No stent78 (60.5)37 (52.1)23 (52.3)
Stent51 (39.5)34 (47.9)21 (47.7)
Laboratory findings
Hemoglobin, g/dL13.1 (9.1-17.2)12.6 (10-16)13 (11.2-16)0.401
Platelet count, × 103238 (59-431)236 (130-487)227 (80-390)0.103
INR1 (0.7-1.34)1.02 (0.89-1.26)1 (0.87-1.47)0.664
Creatinine, mg/dL0.78 (0.38-1.62)0.76 (0.52-2.48)0.77 (0.53-2.15)0.379
Glycemia, mg/dL105 (56-304)92 (77-107)120 (76-267)0.401
Bilirubin, mg/dL2.7 (0.2-26)1.2 (0.2-2.4)4.2 (0.2-28.9)0.475
GOT, IU/L60 (14-571)63 (17-372)79 (12-1140)0.658
GPT, IU/L226 (10-2246)281 (9-1877)228 (8-1407)0.877
GGT, IU/L76 (13-584)117 (13-933)89 (9-1682)0.554
Alkaline phosphatase, U/L274 (39-2262)191 (42-1378)359 (31-1441)0.799
CA19-9, U/mL75.4 (3-13950)28.1 (21-950)16.5 (10-1052)0.004
CEA, ng/mL2.7 (0.1-831)0.53 (0-33.7)2.8 (0.7-48)0.313
Cytology23 (17.8)10 (14.1)5 (11.4)0.545
Table 2 Perioperative variables and histological features among the three groups, n (%)
Variable/feature
EDS group (n = 129)
IDS group (n = 71)
NDS group (n = 44)
P value
Duration of surgery, minutes370 (190-590)430 (300-748)415 (240-710)0.001
Patient transfused14 (10.6)19 (26.8)6 (13.6)0.036
Surgical findings/techniques
Caliber of Wirsung duct, mm3.5 (1-13)3 (2-10)5 (1-17)0.001
Consistency of the pancreas< 0.001
Hard60 (46.5)20 (28.2)31 (70.5)
Soft38 (29.5)16 (22.5)5 (11.4)
Normal31 (24)35 (49.3)8 (18.1)
Pylorus preservation55 (42.6)41 (57.7)26 (59.1)0.051
Vascular resection12 (9.3)6 (8.5)5 (11.4)0.872
Type of reconstruction0.119
One intestinal loop99 (76.7)64 (90.1)37 (86)
Two intestinal loops30 (23.3)7 (9.9)6 (14)
Histological features
Type of tumor0.558
Adenocarcinoma89 (68.9)50 (70.4)29 (65.9)
Cholangiocarcinoma10 (7.7)4 (5.6)3 (6.8)
Neuroendocrine6 (4.6)4 (5.6)4 (9.1)
Other24 (18.6)13 (18.3)8 (18.2)
Degree of differentiation0.991
Good32 (24.8)17 (23.9)11 (25)
Moderate45 (34.9)30 (42.3)20 (45.5)
Poor19 (14.7)12 (16.9)7 (15.9)
Not valuable33 (25.6)12 (16.9)6 (13.6)
Tumor invasion0.339
In situ2 (1.5)1 (1.4)2 (4.5)
< 2 cm20 (15.5)14 (19.7)10 (22.7)
> 2 cm, limited to pancreas36 (27.9)28 (39.4)10 (22.7)
Peripancreatic invasion44 (34.1)20 (18.2)17 (38.6)
Invasion at CA or SMA6 (4.6)1 (1.4)0 (0)
Lymph node invasion71 (55)38 (53.5)25 (56.8)0.938
Number of resected nodes15 (11-38)15 (10-53)13 (8-78)0.602
Number of positive nodes1 (0-11)1 (0-14)1.5 (0-8)0.707
Macrovascular invasion18 (13.9)12 (16.9)8 (18.2)0.961
Microvascular invasion48 (37.2)27 (38)16 (36.4)0.961
Neural invasion61 (47.3)35 (49.3)16 (36.4)0.228
R0 resection84 (65.1)48 (67.6)24 (54.5)0.361
Tumor staging
IA7 (6.7)8 (13.1)4 (10.3)
IB8 (7.6)11 (18)0 (0)
IIA11 (10.5)5 (8.2)7 (17.9)
IIB41 (39)15 (24.6)17 (43.6)
III15 (14.3)11 (18)3 (7.7)
IV4 (3.8)2 (3.3)2 (5.1)
Table 3 Postoperative morbimortality among the three groups, n (%)

EDS group (n = 129)
IDS group (n = 71)
NDS group (n = 44)
P value
C-reactive protein, mg/dL, 3rd day14.6 (0.1-39)20.4 (2-57)10.3 (0.6-33.6)0.054
Medical complications39 (30.3)24 (33.8)17 (38.6)0.307
Surgical complications
Wound infection20 (15.5)12 (16.9)4 (9.3)0.515
Postoperative pancreatic fistula0.009
Grade A/non-POPF108 (83.7)50 (70.5)36 (81.8)
Grade B19 (14.7)11 (15.5)4 (9.1)
Grade C2 (1.6)10 (14.1)4 (9.1)
Delayed gastric emptying0.195
Grade A20 (15.5)12 (16.9)10 (22.7)
Grade B20 (15.5)19 (26.8)6 (13.6)
Grade C7 (5.4)4 (5.6)0 (0)
No delayed gastric emptying82 (63.6)36 (50.7)28 (63.6)
Postoperative hemorrhage0.460
Grade A6 (4.7)4 (5.6)2 (4.5)
Grade B7 (5.4)3 (4.2)4 (9.1)
Grade C3 (2.3)5 (7)4 (9.1)
No postoperative hemorrhage113 (87.6)59 (83.1)34 (77.3)
Reoperations16 (12.4)14 (19.7)9 (20.5)0.063
Hemoperitoneum3 (2.3)4 (5.6)4 (9.1)
Pancreatic fistula2 (1.6)10 (14.1)4 (9.1)
Jejunostomy3 (2.3)0 (0)0 (0)
Other8 (6.2)0 (0)1 (2.3)
Complications, Clavien-Dindo classification
Grade I-II74 (57.3)18 (40.9)25 (35.2)0.007
Grade III-IV26 (20.1)13 (29.5)23 (32.5)0.149
Intensive care unit stay, days2 (1-15)2 (1-30)2 (1-30)0.157
Hospital stay, days17 (5-78)20 (7-97)18 (5-59)0.089
Follow-up
Mortality, 90 days2 (1.6)4 (5.6)2 (4.5)0.046
Morbidity, 90 days90 (70.3)42 (59.1)30 (73.2)0.436
De novo endocrine insufficiency16 (12.4)15 (21.1)6 (13.6)0.293
De novo exocrine insufficiency53 (41.1)30 (42.3)19 (43.2)0.217
Venous thrombosis4 (3.1)5 (7)3 (6.8)0.142
Pulmonary embolism4 (3.1)2 (2.8)0 (0)0.204
Adjuvant chemotherapy62 (48)34 (47.9)22 (50)0.975
Table 4 Results of the logistic binary regression for postoperative pancreatic fistula of grades B/C after pancreaticoduodenectomy
Factor
Odds ratio
P value
95% confidence interval
External duct stent0.4660.0340.231-0.943
Age > 80 years0.5300.3490.140-2.001
ASA III/IV1.4040.3450.695-2.838
Preoperative pancreatitis1.4610.5290.449-4.757
Wirsung duct < 3 mm3.7940.0011.761-8.173
Preoperative biliary drainage0.9240.8270.453-1.883
Soft consistency of pancreas1.0570.8030.683-1.637
Table 5 Results of the logistic binary regression for 90-day mortality after pancreaticoduodenectomy
Factor
Odds ratio
P value
95% confidence interval
External duct stent0.2890.0180.019-0.670
Age > 80 years1.4200.7600.150-13.479
ASA III/IV0.5690.4040.152-2.142
Preoperative pancreatitis0.5320.5830.056-5.052
Wirsung duct < 3 mm4.2230.0311.122-15.252
Preoperative biliary stent0.6150.4630.168-2.253
Soft consistency of pancreas1.3200.5170.565-3.104