Inferior mesenteric vein serves as an alternative guide for transection of the pancreatic body during pancreaticoduodenectomy with concomitant vascular resection: a comparative study evaluating perioperative outcomes

Table 1 Clinical characteristics, operative data, postoperative outcomes, and histopathologic features

Variable	Modified procedures			Standard procedures (n = 75)	P ^b	P ^c	P ^d
Variable	Total (n = 62)	WATIMV (n = 28)	c-PD (n = 34)	Standard procedures (n = 75)	P ^b	P ^c	P ^d
Age (yr) (mean (SD))	57.8 ± 10.9	57.2 ± 10.9	58.1 ± 11.1	56.3 ± 10.8	0.398	0.63	0.87
Sex (Male/Female)	38/24	19/9	19/15	51/24	0.41	0.48	0.99
ASA score, n					0.75	0.89	0.96
1	28	13	15	35
2	24	10	14	25
3	10	5	5	15
Operative data
Length of vein resection, mm (95% CI)	24.19 (22.93 to 25.46)	24.64 (22.67 to 26.61)	23.82(22.1 to 25.54)	20.91 (19.39 to 22.42)	0.002	0.59	0.005
Blood loss, mL (95% CI)	679.8 (557.1 to 802.5)	533.9 (426.7 to 641.2)	800(597.8 to 1002.2)	509.3 (442.7 to 575.9)	0.018	0.013	0.79
Blood loss 500 mL, n	36	13	23	27	0.01	0.012	0.99
Blood transfusion, n	31	10	20	21	0.008	0.07	0.45
Histopathology
Tumor differentiation, n					0.41	0.97	0.66
Well	0	0	0	2
Moderate	22	10	12	28
Poor	40	18	22	45
Overall stage ^a, n					0.14	0.58	0.52
1B	0	0	0	3
2A	34	16	17	47
2B	29	12	17	24
3	0	0	0	0
4	0	0	0	1
Neural invasion, n	39	18	21	24	0.001	0.84	0.003
Vascular invasion, n	46	21	25	27	0.001	0.895	0.001
Depth of venous wall invasion, No					0.001	0.56	0.001
Adventitia	9	3	6	11
Tunica media	24	10	14	10
Intima	13	8	5	6
Lymph node metastasis, n	29	12	17	25	0.11	0.58	0.37
R1 Margin, n	9	1	8	5	0.13	0.06	0.9
Site of positive margin (no. (%))
Pancreas	3	0	3	1
Retroperitoneum	6	1	5	4
Postoperative data
Medical complications, n	30	13	17	35	0.84	0.78	0.98
Grade of complications					0.09	0.83	0.057
0	32	15	17	40
1	9	4	5	13
2	13	5	8	16
3	7	4	3	1
4	0	0	0	4
5 Mortality, n	1	0	1	1
Postoperative hospital stay (days) (mean (SD))	17 ± 9.7	15 ± 7.1	18.6 ± 11.3	14.2 ± 5.8	0.55	0.095	0.67

^aAmerican Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition.
P^bPatients who underwent standard PD with vein resection procedure (s-PD + VR, n = 75) versus modified procedure (m-PD + VR, n = 62).
P^cFurther stratification of the entire cohort of m-PD + VR group, ‘Whipple at IMV’ procedure (WATIMV n = 28) versus transection procedure as in the ‘central pancreatectomy’ (c-PD + VR, n = 34); P ^dPatients who underwent standard PD with vein resection procedure (s-PD + VR, n = 75) versus ‘Whipple at IMV’ procedure (WATIMV, n = 28). ASA, American Society of Anesthesiologists; WATIMV, Whipple at inferior mesenteric vein.

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