Impact of different surgical approaches on prognosis in patients with pancreatic neck cancer: A retrospective cohort study

Table 1 Comparison of clinicopathological characteristics among different surgical procedure groups in patients with pancreatic neck cancer, n (%)/mean ± SD/median (interquartile range)

Variable	Type of surgery			P value
	DP (n = 107)	PD (n = 41)	TP (n = 26)
Gender				0.101
Male	45 (42.1)	20 (48.8)	17 (65.4)
Female	62 (57.9)	21 (51.2)	9 (34.6)
Age (years)	65 (59-70)	64 (59-69)	65 (57-67)	0.472
BMI (kg/m2)	22.93 ± 2.69	23.50 ± 3.14	22.75 ± 2.36	0.445
CA19-9 (U/mL)				0.889
< 37	30 (28.0)	13 (31.7)	8 (30.8)
≥ 37	77 (72.0)	28 (68.3)	18 (69.2)
Tumor size (cm)	2.6 (2-3.2)	2.5 (2-3)	4 (3.225-4.5)	< 0.001
Pathological type				0.875
PDAC	97 (90.7)	39 (95.1)	24 (92.3)
IPMN	7 (6.5)	2 (4.9)	1 (3.8)
Others	3 (2.8)	0 (0)	1 (3.8)
T stage				< 0.001
T1-T2	72 (67.3)	32 (78)	9 (34.6)
T3-T4	35 (32.7)	9 (22)	17 (65.4)
N stage				0.860
N0	62 (57.9)	25 (61.0)	14 (53.8)
N1-N2	45 (42.1)	16 (39.0)	12 (46.2)
Grade				0.436
Poorly differentiated	39 (36.4)	13 (31.7)	12 (46.2)
Moderately differentiated	58 (54.2)	27 (65.9)	13 (50.0)
Well differentiated	10 (9.3)	1 (2.4)	1 (3.8)
Intravascular cancer thrombus	36 (33.6)	14 (34.1)	9 (34.6)	1.000
Nerve invasion	83 (77.6)	35 (85.4)	23 (88.5)	0.382
AJCC stage				0.002
I	47 (43.9)	20 (48.8)	3 (11.5)
IIA	4 (3.7)	0 (0)	1 (3.8)
IIB	28 (26.2)	12 (29.3)	5 (19.2)
III	28 (26.2)	9 (22)	17 (65.4)
Number of dissected lymph nodes	16 (12-23)	16 (11-22)	22 (12.5-34.25)	0.160
Number of metastatic lymph nodes	0 (0-1)	0 (0-1)	0 (0-2)	0.745
Lymph node ratio	0 (0-8.33)	0(0-7.69)	0 (0-8.99)	0.910
Surgical margin				0.852
R0	94 (87.9)	35 (85.4)	22 (84.6)
R1	13 (12.1)	6 (14.6)	4 (15.4)
Operative time (minute)	217.92 ± 68.75	296.37 ± 68.46	359.12 ± 74.79	< 0.001
Intraoperative blood loss (mL)	200 (200-400)	300 (200-500)	650 (375-1725)	< 0.001
Postoperative stay (days)	12 (10-14)	13 (11-14)	14 (12-17)	0.005
Neoadjuvant therapy	25 (23.4)	11 (26.8)	11 (42.3)	0.157
Adjuvant therapy	90 (84.1)	35 (85.4)	15 (57.7)	0.007

DP: Distal pancreatectomy; PD: Pancreaticoduodenectomy; TP: Total pancreatectomy; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; PDAC: Pancreatic ductal adenocarcinoma; IPMN: Intraductal papillary mucinous neoplasm; AJCC: American Joint Committee on Cancer; R0: Microscopically margin-negative resection; R1: Microscopically margin-positive resection.

Table 2 Univariate and multivariate Cox regression analyses of overall survival in all patients, median (interquartile range)

Variable	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Gender
Male	Reference		Reference
Female	0.709 (0.481-1.044)	0.082	0.758 (0.506-1.135)	0.178
Age (years)	1.006 (0.982-1.031)	0.629
BMI (kg/m2)	0.966 (0.898-1.039)	0.348
CA19-9 (U/mL)
< 37 U/mL	Reference
≥ 37 U/mL	1.216 (0.784-1.887)	0.382
Grade
Poorly differentiated	Reference		Reference
Moderately differentiated	0.670 (0.451-0.995)	0.047	0.746 (0.489-1.138)	0.174
Well differentiated	0.312 (0.112-0.870)	0.026	0.311 (0.109-0.888)	0.029
Intravascular cancer thrombus
-	Reference
+	1.076 (0.711-1.628)	0.730
Nerve invasion
-	Reference
+	1.457 (0.865-2.453)	0.157
T stage
T1-T2	Reference		Reference
T3-T4	2.267 (1.539-3.339)	< 0.001	1.840 (1.166-2.905)	0.009
N stage
N0	Reference		Reference
N1 + N2	1.387 (0.944-2.038)	0.095	1.094 (0.736-1.626)	0.656
Surgical margin
R0	Reference		Reference
R1	3.044 (1.834-5.052)	< 0.001	2.226 (1.258-3.938)	0.006
Surgical procedure
DP	Reference		Reference
PD	0.772 (0.467-1.275)	0.312	0.738 (0.442-1.233)	0.246
TP	2.151 (1.309-3.536)	0.003	1.632 (0.933-2.853)	0.086
Postoperative stay (days)	1.002 (0.971-1.033)	0.909
Neoadjuvant therapy
No	Reference
Yes	0.962 (0.522-1.775)	0.902

OS: Overall survival; HR: Hazard ratio; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; R0: Microscopically margin-negative resection; R1: Microscopically margin-positive resection; DP: Distal pancreatectomy; PD: Pancreaticoduodenectomy; TP: Total pancreatectomy.

Table 3 Univariate and multivariate Cox regression analyses of disease-free survival in all patients, median (interquartile range)

Variable	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Gender
Male	Reference
Female	0.796 (0.561-1.128)	0.200
Age (years)	1.003 (0.982-1.024)	0.781
BMI (kg/m2)	0.960 (0.897-1.027)	0.238
CA19-9 (U/mL)
< 37 U/mL	Reference
≥ 37 U/mL	1.333 (0.896-1.985)	0.157
Grade
Poorly differentiated	Reference		Reference
Moderately differentiated	0.713 (0.495-1.028)	0.070	0.752 (0.508-1.113)	0.154
Well differentiated	0.451 (0.204-0.998)	0.050	0.426 (0.186-0.973)	0.043
Intravascular cancer thrombus
-	Reference		Reference
+	1.565 (1.083-2.264)	0.017	1.462 (0.956-2.236)	0.079
Nerve invasion
-	Reference		Reference
+	1.710 (1.048-2.789)	0.032	1.116 (0.659-1.887)	0.684
T stage
T1-T2	Reference		Reference
T3-T4	2.004 (1.404-2.861)	< 0.001	1.761 (1.152-2.691)	0.009
N stage
N0	Reference		Reference
N1 + N2	1.722 (1.214-2.441)	0.002	1.417 (0.963-2.084)	0.077
Surgical margin
R0	Reference		Reference
R1	3.021 (1.855-4.921)	< 0.001	2.312 (1.362-3.927)	0.002
Surgical procedure
DP	Reference		Reference
PD	0.831 (0.533-1.297)	0.416	0.838 (0.532-1.320)	0.446
TP	1.790 (1.119-2.862)	0.015	1.258 (0.761-2.082)	0.371
Postoperative stay (days)	1.001 (0.975-1.028)	0.917

HR: Hazard ratio; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; R0: Microscopically margin-negative resection; R1: Microscopically margin-positive resection; DP: Distal pancreatectomy; PD: Pancreaticoduodenectomy; TP: Total pancreatectomy.