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©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
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, years | 68 (45-86) | 64 (17-85) | 66 (16-89) | 0.091 |
Sex, male/female | 65/64 (50.4/ 49.6) | 43/28 (60.6/39.4) | 24/20 (54.5/45.5) | 0.384 |
ASA score | 0.652 | |||
I-II | 62 (48.1) | 38 (53.6) | 22 (50) | |
III-IV | 67 (51.9) | 33 (46.4) | 22 (50) | |
Body mass index, kg/m2 | 24.6 (16-41) | 25.2 (14-43.3) | 24.5 (18-36.3) | 0.760 |
Comorbidities | ||||
Cardiovascular | 68 (52.7) | 32 (45.1) | 22 (50) | 0.124 |
Hypertension | 59 (45.7) | 31 (43.7) | 16 (36.4) | 0.556 |
Smoker | 28 (21.7) | 17 (23.9) | 8 (18.2) | 0.887 |
Diabetes | 27 (20.9) | 23 (32.4) | 14 (31.8) | 0.109 |
Pulmonary | 24 (18.6) | 18 (25.3) | 8 (18.2) | 0.096 |
Tumor | 19 (14.7) | 9 (12.7) | 8 (18.2) | 0.549 |
Alcohol use | 18 (14) | 10 (14.1) | 4 (9.1) | 0.886 |
Neoadjuvant chemotherapy | 19 (14.7) | 7 (9.9) | 2 (4.5) | 0.165 |
Clinical | ||||
Jaundice | 84 (65.1) | 42 (59.2) | 24 (54.5) | 0.412 |
Weight loss | 72 (55.8) | |||
Abdominal pain | 62 (48.1) | 25 (35.2) | 18 (40.9) | 0.204 |
Cholangitis | 24 (18.6) | 13 (18.3) | 8 (18.2) | 0.997 |
Preoperative pancreatitis | 10 (7.8) | 6 (8.5) | 12 (27.3) | 0.001 |
Duodenal obstruction | 9 (7) | 4 (5.6) | 0 (0) | 0.203 |
Upper gastrointestinal bleeding | 8 (6.2) | 3 (4.2) | 2 (4.5) | 0.811 |
Diagnostic examinations/findings | ||||
CT scan | 126 (97.7) | 69 (97.2) | 43 (97.7) | 0.973 |
MRI | 91 (70.5) | 53 (74.6) | 30 (68.2) | 0.728 |
Endoscopic ultrasound | 73 (56.6) | 49 (69) | 27 (61.4) | 0.226 |
ERCP | 64 (49.6) | 38 (53.5) | 23 (52.3) | 0.886 |
PTHC | 19 (14.7) | 8 (11.3) | 3 (6.8) | 0.368 |
Tumor size, cm | 2.2 (0.1-6) | 2.1 (0.2-7.1) | 2 (0.2-5.5) | 0.653 |
Bile duct size, cm | 1.2 (0.3-2.5) | 1.2 (0.2-2.4) | 1 (0.2-3.1) | 0.303 |
Preoperative biliary stent | 0.127 | |||
No stent | 78 (60.5) | 37 (52.1) | 23 (52.3) | |
Stent | 51 (39.5) | 34 (47.9) | 21 (47.7) | |
Laboratory findings | ||||
Hemoglobin, g/dL | 13.1 (9.1-17.2) | 12.6 (10-16) | 13 (11.2-16) | 0.401 |
Platelet count, × 103 | 238 (59-431) | 236 (130-487) | 227 (80-390) | 0.103 |
INR | 1 (0.7-1.34) | 1.02 (0.89-1.26) | 1 (0.87-1.47) | 0.664 |
Creatinine, mg/dL | 0.78 (0.38-1.62) | 0.76 (0.52-2.48) | 0.77 (0.53-2.15) | 0.379 |
Glycemia, mg/dL | 105 (56-304) | 92 (77-107) | 120 (76-267) | 0.401 |
Bilirubin, mg/dL | 2.7 (0.2-26) | 1.2 (0.2-2.4) | 4.2 (0.2-28.9) | 0.475 |
GOT, IU/L | 60 (14-571) | 63 (17-372) | 79 (12-1140) | 0.658 |
GPT, IU/L | 226 (10-2246) | 281 (9-1877) | 228 (8-1407) | 0.877 |
GGT, IU/L | 76 (13-584) | 117 (13-933) | 89 (9-1682) | 0.554 |
Alkaline phosphatase, U/L | 274 (39-2262) | 191 (42-1378) | 359 (31-1441) | 0.799 |
CA19-9, U/mL | 75.4 (3-13950) | 28.1 (21-950) | 16.5 (10-1052) | 0.004 |
CEA, ng/mL | 2.7 (0.1-831) | 0.53 (0-33.7) | 2.8 (0.7-48) | 0.313 |
Cytology | 23 (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, minutes | 370 (190-590) | 430 (300-748) | 415 (240-710) | 0.001 |
Patient transfused | 14 (10.6) | 19 (26.8) | 6 (13.6) | 0.036 |
Surgical findings/techniques | ||||
Caliber of Wirsung duct, mm | 3.5 (1-13) | 3 (2-10) | 5 (1-17) | 0.001 |
Consistency of the pancreas | < 0.001 | |||
Hard | 60 (46.5) | 20 (28.2) | 31 (70.5) | |
Soft | 38 (29.5) | 16 (22.5) | 5 (11.4) | |
Normal | 31 (24) | 35 (49.3) | 8 (18.1) | |
Pylorus preservation | 55 (42.6) | 41 (57.7) | 26 (59.1) | 0.051 |
Vascular resection | 12 (9.3) | 6 (8.5) | 5 (11.4) | 0.872 |
Type of reconstruction | 0.119 | |||
One intestinal loop | 99 (76.7) | 64 (90.1) | 37 (86) | |
Two intestinal loops | 30 (23.3) | 7 (9.9) | 6 (14) | |
Histological features | ||||
Type of tumor | 0.558 | |||
Adenocarcinoma | 89 (68.9) | 50 (70.4) | 29 (65.9) | |
Cholangiocarcinoma | 10 (7.7) | 4 (5.6) | 3 (6.8) | |
Neuroendocrine | 6 (4.6) | 4 (5.6) | 4 (9.1) | |
Other | 24 (18.6) | 13 (18.3) | 8 (18.2) | |
Degree of differentiation | 0.991 | |||
Good | 32 (24.8) | 17 (23.9) | 11 (25) | |
Moderate | 45 (34.9) | 30 (42.3) | 20 (45.5) | |
Poor | 19 (14.7) | 12 (16.9) | 7 (15.9) | |
Not valuable | 33 (25.6) | 12 (16.9) | 6 (13.6) | |
Tumor invasion | 0.339 | |||
In situ | 2 (1.5) | 1 (1.4) | 2 (4.5) | |
< 2 cm | 20 (15.5) | 14 (19.7) | 10 (22.7) | |
> 2 cm, limited to pancreas | 36 (27.9) | 28 (39.4) | 10 (22.7) | |
Peripancreatic invasion | 44 (34.1) | 20 (18.2) | 17 (38.6) | |
Invasion at CA or SMA | 6 (4.6) | 1 (1.4) | 0 (0) | |
Lymph node invasion | 71 (55) | 38 (53.5) | 25 (56.8) | 0.938 |
Number of resected nodes | 15 (11-38) | 15 (10-53) | 13 (8-78) | 0.602 |
Number of positive nodes | 1 (0-11) | 1 (0-14) | 1.5 (0-8) | 0.707 |
Macrovascular invasion | 18 (13.9) | 12 (16.9) | 8 (18.2) | 0.961 |
Microvascular invasion | 48 (37.2) | 27 (38) | 16 (36.4) | 0.961 |
Neural invasion | 61 (47.3) | 35 (49.3) | 16 (36.4) | 0.228 |
R0 resection | 84 (65.1) | 48 (67.6) | 24 (54.5) | 0.361 |
Tumor staging | ||||
IA | 7 (6.7) | 8 (13.1) | 4 (10.3) | |
IB | 8 (7.6) | 11 (18) | 0 (0) | |
IIA | 11 (10.5) | 5 (8.2) | 7 (17.9) | |
IIB | 41 (39) | 15 (24.6) | 17 (43.6) | |
III | 15 (14.3) | 11 (18) | 3 (7.7) | |
IV | 4 (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 day | 14.6 (0.1-39) | 20.4 (2-57) | 10.3 (0.6-33.6) | 0.054 |
Medical complications | 39 (30.3) | 24 (33.8) | 17 (38.6) | 0.307 |
Surgical complications | ||||
Wound infection | 20 (15.5) | 12 (16.9) | 4 (9.3) | 0.515 |
Postoperative pancreatic fistula | 0.009 | |||
Grade A/non-POPF | 108 (83.7) | 50 (70.5) | 36 (81.8) | |
Grade B | 19 (14.7) | 11 (15.5) | 4 (9.1) | |
Grade C | 2 (1.6) | 10 (14.1) | 4 (9.1) | |
Delayed gastric emptying | 0.195 | |||
Grade A | 20 (15.5) | 12 (16.9) | 10 (22.7) | |
Grade B | 20 (15.5) | 19 (26.8) | 6 (13.6) | |
Grade C | 7 (5.4) | 4 (5.6) | 0 (0) | |
No delayed gastric emptying | 82 (63.6) | 36 (50.7) | 28 (63.6) | |
Postoperative hemorrhage | 0.460 | |||
Grade A | 6 (4.7) | 4 (5.6) | 2 (4.5) | |
Grade B | 7 (5.4) | 3 (4.2) | 4 (9.1) | |
Grade C | 3 (2.3) | 5 (7) | 4 (9.1) | |
No postoperative hemorrhage | 113 (87.6) | 59 (83.1) | 34 (77.3) | |
Reoperations | 16 (12.4) | 14 (19.7) | 9 (20.5) | 0.063 |
Hemoperitoneum | 3 (2.3) | 4 (5.6) | 4 (9.1) | |
Pancreatic fistula | 2 (1.6) | 10 (14.1) | 4 (9.1) | |
Jejunostomy | 3 (2.3) | 0 (0) | 0 (0) | |
Other | 8 (6.2) | 0 (0) | 1 (2.3) | |
Complications, Clavien-Dindo classification | ||||
Grade I-II | 74 (57.3) | 18 (40.9) | 25 (35.2) | 0.007 |
Grade III-IV | 26 (20.1) | 13 (29.5) | 23 (32.5) | 0.149 |
Intensive care unit stay, days | 2 (1-15) | 2 (1-30) | 2 (1-30) | 0.157 |
Hospital stay, days | 17 (5-78) | 20 (7-97) | 18 (5-59) | 0.089 |
Follow-up | ||||
Mortality, 90 days | 2 (1.6) | 4 (5.6) | 2 (4.5) | 0.046 |
Morbidity, 90 days | 90 (70.3) | 42 (59.1) | 30 (73.2) | 0.436 |
De novo endocrine insufficiency | 16 (12.4) | 15 (21.1) | 6 (13.6) | 0.293 |
De novo exocrine insufficiency | 53 (41.1) | 30 (42.3) | 19 (43.2) | 0.217 |
Venous thrombosis | 4 (3.1) | 5 (7) | 3 (6.8) | 0.142 |
Pulmonary embolism | 4 (3.1) | 2 (2.8) | 0 (0) | 0.204 |
Adjuvant chemotherapy | 62 (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 stent | 0.466 | 0.034 | 0.231-0.943 |
Age > 80 years | 0.530 | 0.349 | 0.140-2.001 |
ASA III/IV | 1.404 | 0.345 | 0.695-2.838 |
Preoperative pancreatitis | 1.461 | 0.529 | 0.449-4.757 |
Wirsung duct < 3 mm | 3.794 | 0.001 | 1.761-8.173 |
Preoperative biliary drainage | 0.924 | 0.827 | 0.453-1.883 |
Soft consistency of pancreas | 1.057 | 0.803 | 0.683-1.637 |
Table 5 Results of the logistic binary regression for 90-day mortality after pancreaticoduodenectomy
Factor | Odds ratio | P value | 95% confidence interval |
External duct stent | 0.289 | 0.018 | 0.019-0.670 |
Age > 80 years | 1.420 | 0.760 | 0.150-13.479 |
ASA III/IV | 0.569 | 0.404 | 0.152-2.142 |
Preoperative pancreatitis | 0.532 | 0.583 | 0.056-5.052 |
Wirsung duct < 3 mm | 4.223 | 0.031 | 1.122-15.252 |
Preoperative biliary stent | 0.615 | 0.463 | 0.168-2.253 |
Soft consistency of pancreas | 1.320 | 0.517 | 0.565-3.104 |
- Citation: Jiménez-Romero C, Marcacuzco-Quinto A, Caso-Maestro O, Alonso L, Fernández-Fernández C, Justo I. Comparison of three reconstruction techniques performed after pancreaticoduodenectomy: Using external, internal, or no stent. World J Gastrointest Surg 2025; 17(6): 104652
- URL: https://www.wjgnet.com/1948-9366/full/v17/i6/104652.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v17.i6.104652