Early predictive factors for severe postoperative complications following major liver and pancreatic surgery: A single-center retrospective study

Early predictive factors for severe postoperative complications following major liver and pancreatic surgery: A single-center retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early predictive factors for severe postoperative complications following major liver and pancreatic surgery: A single-center retrospective study Masahiro Fukada, Noriki Mitsui, Takeshi Horaguchi, Itaru Yasufuku, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7493031/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Postoperative severe complications (PSC) serve as critical metrics of surgical performance, significantly escalating healthcare expenditure, impeding timely initiation of adjuvant chemotherapy, and compromising long-term survival. Generally speaking, hepato-bilially-pancreatic surgeons are required to have the ability to perform and manage both liver and pancreatic surgery, which are different in nature. Therefore, it is important to have a comprehensive understanding of both liver and pancreatic surgery.This investigation aims to identify perioperative predictive factors for PSC after these surgeries. Methods This single-center retrospective study enrolled 675 patients who underwent major liver and pancreatic surgeries between January 2010 and December 2023 at Gifu University Hospital, Japan. Perioperative predictive factors were evaluated in 328 patients with both PSC (n = 167; liver n = 49, pancreas n = 118; Clavien–Dindo (CD) classification grades ≥ III) and non-PSC (n = 161; liver n = 53, pancreas n = 108; CD classification grades < III) using univariate and multivariate analyses. Results PSC after major pancreatic surgery was significantly associated with male sex (p = 0.01), higher BMI (p = 0.03), history of smoking (p = 0.02), history of malignancy (p = 0.02), respiratory-related comorbidity (p = 0.04), and CAR, NLR, and PLR on POD3 (p < 0.001, p < 0.01, and p 5.0, OR, 4.27; 95% CI, 2.05–9.13; p < 0.001) was an independent predictive factor for PSC after major pancreatic surgery. On the other hands, PSC after major liver surgery was significantly associated with an abnormal CONUT score (p = 0.04) and heart-related comorbidities (p = 0.04) in the univariate analysis. In the multivariate analysis, only an abnormal CONUT score (OR, 3.40; 95% CI, 1.37–8.81; p < 0.01) was an independent predictive factor for PSC following major liver surgery . Conclusions Postoperative inflammatory markers may be early predictive factors for complication severity after major pancreatectomy. On the other hand, an abnormal preoperative CONUT score was an independent predictor of major liver surgery. The study advocates for the implementation of proactive postoperative strategies guided by inflammatory biomarkers in major pancreatic surgery and posits that targeted nutritional optimization prior to major hepatectomy may facilitate expedited recovery and favorable outcomes. postoperative severe complication major liver and pancreatic surgery inflammatory marker controlling nutritional status Figures Figure 1 Background Surgery is an effective treatment approach for malignant diseases, thereby improving patient prognosis. However, postoperative complications can be severe and life-threatening. Among the many types of abdominal surgery, major liver and pancreatic surgeries require advanced techniques and are associated with high postoperative complications and mortality rates [ 1 ]. To monitor surgical safety in Japan, the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) established systems for the board certification of training institutions in 2008 and expert surgeons in 2011. As of July 2024, 653 JSHBPS-certified expert surgeons perform advanced hepatobiliary pancreatic surgery (HBPS) at 307 training institutions nationwide. These efforts have contributed to better postoperative outcomes in Japan than in other countries [ 2 – 11 ]. Owing to these systems, the postoperative mortality rates of highly advanced HBPS for all board-certified institutions decreased from 2012 to 2019 (30-day: 0.92–0.52% and 90-day: 2.1–0.98%) [ 12 ]. The Gifu University Hospital is board-certified, and we reported a 90-day postoperative mortality rate of 1.3%, comparable to that of other board-certified institutions, as well as the results of a mortality risk factor analysis [ 13 ]. Although preventing surgery-related mortality is crucial, preventing severe postoperative complications associated with major liver and pancreatic surgeries is essential. Addressing this issue is vital for ensuring the smooth introduction of postoperative adjuvant treatment and reducing medical costs. However, HBP surgeons are generally required to have the ability to perform and manage both liver and pancreatic surgery, which are different in nature, in clinical practice. Therefore, it is important for HBP surgeons to have a comprehensive understanding of both liver and pancreatic surgery. Thus, this study aimed to identify perioperative (preoperative, intraoperative, and postoperative) predictive factors for postoperative severe complications (PSC) following each major liver and pancreatic surgery. Methods Study design and setting This study retrospectively analyzed 675 patients who underwent major liver and pancreatic surgeries at Gifu University Hospital, a certified training facility by JSHBPS, from January 2010 to December 2023. All highly level HBPS procedures were performed by experienced board-certified, JSHBPS-qualified surgeons. The study aimed to determine perioperative predictors of PSC following major liver and pancreatic surgery. Approval was granted by the Gifu University Ethics Committee (approval no. 2023-018). In line with the Declaration of Helsinki, informed consent was waived due to the study’s retrospective design. Definition of severe postoperative complications The primary outcome was PSC following major liver and pancreatic surgery, defined as a postoperative complication of grade ≥III (requiring radiologic intervention or reoperation) using the Clavien–Dindo (CD) classification. Non-PSC was defined as a postoperative complication of grade II (requiring antibiotic therapy) or grade I (resolved without treatment) using the CD classification. Preoperative, intraoperative, and postoperative variables We examined a comprehensive range of variables spanning the preoperative, intraoperative, and postoperative periods. Preoperative parameters encompassed demographic and clinical characteristics (e.g., age, sex, BMI, ASA classification, smoking status, prior abdominal surgery, preoperative chemotherapy), nutritional and inflammatory indices (PNI, CONUT, CAR, NLR, PLR), and comorbidities (Charlson comorbidity index and types of comorbid conditions). Intraoperative factors included type of surgery, additional organ resections, operative time, intraoperative blood loss, and transfusion requirements. Postoperative data comprised date of complication diagnosis, arterial lactate levels on postoperative day (POD) 1, and inflammatory markers on POD 3. Major liver and pancreatic surgery Major liver surgeries include hepatic trisegmentectomy, hemihepatectomy, hepatic sectionectomy (except lateral sectionectomy), and hepatic segmentectomy (S1, S2, S3, S5, S6, S7, S8). Additionally, pancreatic surgeries include total pancreatectomy, pancreaticoduodenectomy (PD), left pancreatectomy with lymph node dissection, and middle segment pancreatectomy (MP). This study excluded hepatobiliary surgeries involving biliary resection and reconstruction, such as hepatectomy with extrahepatic bile duct resection, extrahepatic bile duct resection for congenital biliary dilatation, and hepatopancreatectomy. At our institution, the surgical indications for major hepatectomy typically include (i) Child-Pugh classification grade A and (ii) a scheduled residual liver indocyanine green (ICG) disappearance rate, calculated as ([ICG disappearance rate] × [ratio of expected residual liver volume to total liver volume]) > 0.05. Liver volume was calculated using SYNAPSE VINCENT (Fujifilm Medical Co., Ltd., Tokyo, Japan) based on preoperative contrast-enhanced computed tomography images. Additionally, all patients underwent a preoperative consultation with an anesthesiologist for surgical clearance. Statistical analyses Data presentation adhered to standard conventions, with continuous variables expressed as medians (range) and categorical variables as counts (percentages). Between-group comparisons employed Fisher’s exact and Mann–Whitney U tests. Optimal thresholds for ROC analysis were determined via Youden’s index. Variables yielding p < 0.10 in univariate models were included in multivariate logistic regression. Statistical significance was defined as p < 0.05 (two-tailed). All analyses were conducted using JMP software (SAS Institute Inc., Cary, NC, USA). Results Patients This study included 675 patients who underwent major liver or pancreatic surgeries. We excluded 347 (51.4%) patients who did not experience postoperative complications. In total, 328 (48.6%) patients who experienced at least one postoperative complication of CD grade ≥ I were evaluated for risk factors associated with PSC. According to the CD grading system, 53 (52.0%) patients had non-PSC, and 49 (48.0%) had PSC after major liver surgery, and 108 (47.8%%) patients had non-PSC, and 118 (52.2%) had PSC after major pancreatic surgery ( Figure 1 ). Types of postoperative complications following major liver and pancreatic surgery Table 1 summarizes the types of postoperative complications after major liver and pancreatic surgeries. Significant differences were found in type-specific surgical complications, such as pancreatic fistula, delayed gastric emptying, bile leakage, and hepatic failure (all p<0.001). Regarding nonspecific surgical complications, pneumonia was significantly more common in pancreatic surgery (p=0.048), whereas ileus and pleural effusion were more frequent in liver surgery (p=0.046 and p<0.001, respectively). Other non-specific surgical complications and postoperative hemorrhage, reoperation, and operative mortality did not differ significantly between liver and pancreatic surgeries. P ostoperative complication rates according to major liver and pancreatic surgery type Table 2 summarizes the postoperative complication rates according to the type of major liver and pancreatic surgeries. Regarding hepatectomy, a trend towards an increased incidence of postoperative complications with more extensive resection was observed. When patients who underwent hepatic trisegmentectomy were excluded, the rates of PSC and non-PSC were similar (15.9% and 17.2%, respectively). Conversely, in pancreatic surgery, postoperative complications appeared to increase with procedures involving pancreatoenteric anastomosis (PD and MP). Compared with hepatectomy, the incidence of postoperative complications was higher; however, the rates of PSC and non-PSC after pancreatic surgery were similar (32.2% and 29.5%, respectively). Comparison of patient characteristics between P SC and non- P SC groups Supplemental Table 1 compares patient characteristics between the PSC and non-PSC groups. Patients in the PSC group had significantly longer hospital stays (p<0.001) than those in the non-PSC group. Additionally, the PSC group was more likely to be male (p=0.06), have a history of smoking (p=0.07), have an abnormal CONUT score (≥2, p=0.08), and have a higher rate of respiratory-related comorbidities (p=0.07) than the non-PSC group. No significant differences were observed in the intraoperative variables between the groups. Univariate and multivariate analyses to predict PSC in patients following major pancreatic surgery In the univariate analysis, PSC after major pancreatic surgery was significantly associated with male sex (p=0.01), higher BMI (p=0.03), history of smoking (p=0.02), history of malignancy (p=0.02), respiratory-related comorbidity (p=0.04), and CAR, NLR, and PLR on POD3 (p<0.001, p<0.01, and p<0.01, respectively). Additionally, a higher Charlson Comorbidity Index (p=0.09) showed a significant association. Conversely, intraoperative factors, including the presence of pancreatic-enteric anastomosis (PD and MP), showed no significant differences. Finally, in the multivariate analysis, only CAR on POD3 (>5.0, OR, 4.27; 95% CI, 2.05–9.13; p<0.001) was an independent predictive factor for PSC after major pancreatic surgery ( Table 3 ). Univariate and multivariate analyses to predict P SC in patients following major liver surgery In the univariate analysis, PSC after major liver surgery was significantly associated with an abnormal CONUT score (p=0.04) and heart-related comorbidities (p=0.04). Additionally, cerebrovascular comorbidities showed a significant trend (p=0.05). However, intraoperative factors, including extensive liver resection (trisegmentectomy and hemihepatectomy) and postoperative-related factors, did not show significant differences. Finally, in the multivariate analysis, only an abnormal CONUT score (OR, 3.40; 95% CI, 1.37–8.81; p<0.01) was an independent predictive factor for PSC following major liver surgery ( Table 4). Discussion This study investigated perioperative predictive factors for severe postoperative complications after major liver and pancreatic surgeries. PSC rates at our institution were 15.9% after major hepatectomy and 32.2% after major pancreatectomy, with PD accounting for 35.0% of the cases. According to the 2021 National Clinical Database report in Japan, PSC rates in board-certified training institutions were 23.5% after major hepatectomy and 39.7% after PD [ 14 ]. The postoperative outcomes in this study were comparable to those of other board-certified training institutions. Therefore, facilitating the recognition of the signs of severe complications is necessary to improve postoperative outcomes. First, the severity of postoperative complications increases the direct burden on patients by requiring invasive treatment such as radiological intervention or reoperation. Additionally, it increases postoperative hospital stay. In this study, PSC was associated with a longer hospital stay for both liver and pancreatic surgeries (liver surgery: PSC vs. non-PSC, 35 vs. 19 days, p < 0.001; pancreatic surgery: PSC vs. non-PSC, 42 vs. 27 days, p < 0.001). Thus, prolonged hospital stay caused by PSC increases patient burden and medical costs and may negatively impact postoperative treatment [ 15 – 17 ]. Matsuda et al. reported that infectious postoperative complications diminished the effectiveness of adjuvant chemotherapy and induced impaired oncological outcomes in a multicenter retrospective cohort study involving 1817 patients with curative-stage colorectal cancer [ 18 ]. For pancreatic and cholangiocarcinoma cancers requiring postoperative adjuvant chemotherapy, Macfie et al. reported that patients who experienced PSC had lower rates of adjuvant therapy and worse recurrence-free survival [ 19 ]. Notably, adjuvant chemotherapy complication rates after major pancreatectomy still result in a high morbidity rate [ 20 – 25 ], with recent prospective randomized trials showing only 40–63% of patients completing all planned therapies [ 21 , 26 ]. These studies suggest that the negative impact of PSC on postoperative adjuvant therapy is high and leads to a worse long-term prognosis. Additionally, PSC may directly impair survival by producing and activating inflammatory cytokines that promote micrometastasis [ 27 ]. PSCs induce high levels of hepatocyte growth factors and stress-induced oxidized lipids, promoting metastasis and tumor progression [ 28 , 29 ]. In summary, preventing PSC may improve long-term prognosis from the following perspectives: i) smooth introduction of adjuvant chemotherapy and ii) suppression of local and systemic postoperative inflammation. Second, this study revealed that abnormally high levels of postoperative inflammatory markers may be independent predictive factors for PSC after major pancreatic surgeries. Additionally, whereas preoperative factors, such as male sex, high BMI, smoking history, comorbidities, and CONUT score, significantly correlated with PSC in the univariate analyses, no significant differences were found for intraoperative factors. We hypothesize that this result is because of the following factors: (i) complications following major pancreatectomy include a higher frequency of infectious complications, such as pancreatic fistula and pneumonia, (ii) surgeries were performed using standardized procedures by board-certified surgeons at a single certified training institution, and (iii) strictly-defined surgical indications, particularly for major liver surgery. The analysis identified the CAR on POD3 as an independent predictor of PSC after major pancreatic surgery. CAR is a novel inflammatory marker that has demonstrated prognostic value in various inflammatory and malignant conditions [ 30 , 31 ]. It reflects the systemic inflammatory response by combining CRP, a positive acute-phase protein, and albumin, a negative acute-phase reactant whose serum concentration decreases as inflammation worsens [ 32 , 33 ]. Consequently, CAR serves as a dynamic, individualized indicator of acute-phase inflammatory intensity. A well-documented correlation exists between systemic inflammation and the severity of postoperative complications [ 34 ]. Recently, Sakamoto et al. reported that CAR on POD3 is a reliable marker for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy, with an optimal cutoff of 7.4 based on receiver operating characteristic (ROC) analysis [ 35 ]. This value is close to the threshold identified in our study (5.0), underscoring CAR’s potential as a practical and accessible tool for early risk stratification in major pancreatic surgery. This study found that preoperative nutritional assessment using the CONUT score was an independent predictor of complication severity after major hepatectomy. The CONUT score, developed as a nutritional screening tool, is calculated based on serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration [ 36 ]. A higher score indicates severe malnutrition. The CONUT score, similar to the PNI, is a useful and simple method for assessing nutritional status. However, the CONUT score has a stronger association with anthropometric values than the PNI score, which was associated with hepatic function [ 37 ]. Takagi et al. reported that a preoperative high CONUT score (≥ 3) is associated with worse hepatic functional reserve and a higher incidence of major postoperative complications in patients with hepatocellular carcinoma [ 38 ]. Additionally, this study revealed that an abnormal CONUT score was a better predictor of complication severity following major liver surgery than the PNI. Therefore, a safer major hepatectomy may be achieved by adding the CONUT score to the conventional Child-Pugh classification for liver function assessment. Preoperative nutritional enhancement interventions may help reduce the risk of developing severe diseases. Several limitations merit consideration. This retrospective, single-center design may inherently limit generalizability due to potential selection bias and analytical multiplicity. Although multicenter trials offer broader applicability, inter-institutional variability may confound results. Hence, this study—conducted in a single, highly standardized medical environment—may still offer valuable insight. Additionally, while POD3 inflammatory markers were evaluated, the ideal time point and threshold require further validation. These caveats should inform interpretation. Conclusions In patients with postoperative complications after major pancreatic surgery, inflammatory markers may be early predictive factors of severity. Additionally, this study identified an abnormal CONUT score as an independent predictor of major liver surgery. The results highlight the value of early, inflammation-based postoperative management after major pancreatic surgery, and suggest that enhancing preoperative nutrition prior to major hepatectomy may shorten postoperative hospital stays and improve outcomes following major liver and pancreatic surgery. Abbreviations JSHBPS, Japanese Society of Hepato-Biliary-Pancreatic Surgery; HBPS, hepatobiliary-pancreatic surgery; PSC, Postoperative severe complication; CD, Clavien–Dindo; BMI, body mass index; PNI, Prognostic nutritional index; CONUT, controlling nutritional status; CAR, C-reactive protein to albumin ratio; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; POD, postoperative day; PD, pancreaticoduodenectomy; MP, middle pancreatectomy; ICG, indocyanine green; OR, odds ratio; CI, confidence interval; CR-POPF, clinically relevant postoperative pancreatic fistula Declarations Ethics approval and consent to participate: This study was conducted in accordance with the World Medical Association Declaration of Helsinki and approved by the Ethics Committee of Gifu University (approval number: 2023-018). This retrospective study did not include any potentially identifiable patient data; therefore, the need for informed consent was waived by the Ethics Committee of Gifu University. This retrospective study was approved by the Institutional Review Board. Clinical trial number: Not applicable Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analyzed in this study are available from the corresponding author upon reasonable request. Competing interests: The authors declare no competing interests. Funding : Not applicable Authors’ contributions: MF conceived the study concept, planned the study design as the principal investigator, interpreted the results, and drafted the manuscript. NM revised the manuscript, added intellectual content, and provided critical advice. MF, NM, TH, IY, YS, JYT, YT, and NM obtained the data, provided critical comments to improve the manuscript, and approved its final submission. All the authors have read and approved the final manuscript. Acknowledgments: The authors thank the medical staff of the Department of Gastroenterological Surgery at Gifu University Hospital for their participation in this study. We could not have completed this study without their diligence or support. We would like to thank Editage (www.editage.jp) for the English language editing. References Csikesz NG, Simons JP, Tseng JF, Shah SA. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg. 2008;12:1534-9. doi: 10.1007/s11605-008-0566-z Aloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB. 2009;11:510-5. doi: 10.1111/j.1477-2574.2009.00095.x Virani S, Michaelson JS, Hutter MM, Lancaster RT, Warshaw AL, Henderson WG, et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg. 2007;204:1284-92. doi: 10.1016/j.jamcollsurg.2007.02.067 Tzeng CW, Cooper AB, Vauthey JN, Curley SA, Aloia TA. Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients. HPB. 2014;16:459-68. doi: 10.1111/hpb.12155 Madhavan S, Shelat VG, Soong SL, Woon WWL, Huey T, Chan YH, et al. Predicting morbidity of liver resection. Langenbeck's Arch Surg. 2018;403:359-69. doi: 10.1007/s00423-018-1656-3 Khaoudy I, Farges O, Boleslawski E, Vibert E, Soubrane O, Adham M, et al. Half of postoperative deaths after hepatectomy may be preventable: a root-cause analysis of a prospective multicenter cohort study. Ann Surg. 2018;268:792-8. doi: 10.1097/SLA.0000000000002837 Wiggers JK, Koerkamp BG, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, et al. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg. 2016;223:321-31. doi: 10.1016/j.jamcollsurg.2016.03.035 Launois B, Reding R, Lebeau G, Buard JL. Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepatobiliary Pancreat Surg. 2000;7:128-34. doi: 10.1007/s005340050166 Nuzzo G, Giuliante F, Ardito F, Giovannini I, Aldrighetti L, Belli G, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg. 2012;147:26-34. doi: 10.1001/archsurg.2011.771 Glasgow RE, Jackson HH, Neumayer L, Schifftner TL, Khuri SF, Henderson WG, et al. Pancreatic resection in Veterans Affairs and selected university medical centers: results of the patient Safety in surgery study. J Am Coll Surg. 2007;204:1252-60. doi: 10.1016/j.jamcollsurg.2007.03.015 Wegner RE, Verma V, Hasan S, Schiffman S, Thakkar S, Horne ZD, et al. Incidence and risk factors for post-operative mortality, hospitalization, and readmission rates following pancreatic cancer resection. J Gastrointest Oncol. 2019;10:1080-93. doi: 10.21037/jgo.2019.09.01 Otsubo T, Kobayashi S, Sano K, Misawa T, Katagiri S, Nakayama H, et al. A nationwide certification system to increase the safety of highly advanced hepatobiliary-pancreatic surgery. J Hepatobiliary Pancreat Sci. 2023;30:60-71. doi: 10.1002/jhbp.1186. Fukada M, Murase K, Higashi T, Yasufuku I, Sato Y, Tajima JY, et al. Perioperative predictive factors of failure to rescue following highly advanced hepatobiliary-pancreatic surgery: a single-institution retrospective study. World J Surg Oncol. 2023;21:365. doi: 10.1186/s12957-023-03257-6. Endo I, Hirahara N, Miyata H, Yamamoto H, Matsuyama R, Kumamoto T, et al. Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: an analysis of patients registered in the National Clinical Database in Japan. J Hepatobiliary Pancreat Sci. 2021;28:305-16. doi: 10.1002/jhbp.918. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261:497-505. doi: 10.1097/SLA.0000000000000854 Goto S, Hasegawa S, Hida K, Uozumi R, Kanemitsu Y, Watanabe T, et al. Multicenter analysis of impact of anastomotic leakage on long-term oncologic outcomes after curative resection of colon cancer. Surgery. 2017;162:317-24. doi: 10.1016/j.surg.2017.03.005 Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890-9. doi: 10.1097/SLA.0b013e3182128929 Matsuda A, Maruyama H, Akagi S, Inoue T, Uemura K, Kobayashi M, et al. Do postoperative infectious complications really affect long-term survival in colorectal cancer surgery? A multicenter retrospective cohort study. Ann Gastroenterol Surg. 2022;7:110-20. doi: 10.1002/ags3.12615. Macfie R, Berger Y, Liu H, Li T, Imtiaz S, Ang C, et al. Major postoperative complications limit adjuvant therapy administration in patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma or pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2023;30:5027-34. doi: 10.1245/s10434-023-13533-0. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530-6. doi: 10.1016/j.jamcollsurg.2014.12.031 Versteijne E, Sucher M, Groothuis K, Akkermans-Vogelaar JM, Besselink MG, Bonsing BA, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial. J Clin Oncol. 2020;38:1763-73. doi: 10.1200/JCO.19.02274. Wu W, He J, Cameron J, Makary M, Soares K, Ahuja N, et al. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol. 2014;21:2873-81. doi: 10.1245/s10434-014-3722-6. Conroy T, Desseingne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817-25. doi: 10.1056/NEJMoa1011923. Neoptolemos J, Palmer D, Ghana P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389:1011-24. doi: 10.1016/S0140-6736(16)32409-6. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308:147-56. doi: 10.1001/jama.2012.7352 Sohal D, Duong MT, Ahmad SA, Gandhi N, Beg MS, Wang-Gillam A, et al. SWOG S1505: results of perioperative chemotherapy (peri-op CTx) with mfolfirinox versus gemcitabine/nab-paclitaxel (Gem/nabP) for resectable pancreatic ductal adenocarcinoma (PDA). J Clin Oncol. 2020;38:4504. doi: 10.1200/JCO.2020.38.15_suppl.4504. Bohle B, Pera M, Pascual M, Alonso S, Mayol X, Salvado M, et al. Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery. 2010;147:120-6. doi: 10.1016/j.surg.2009.06.035. Tsujimoto H, Horiguchi H, Matsumoto Y, Takahata R, Shinomiya N, Yamori T, et al. A potential mechanism of tumor progression during systemic infections via the hepatocyte growth factor (HGF)/c-Met signaling pathway. J Clin Med. 2020;9:2074. doi: 10.3390/jcm90 72074. Perego M, Tyurin VA, Tyurina YY, Yellets J, Nacarelli T, Lin C, et al. Reactivation of dormant tumor cells by modified lipids derived from stress-activated neutrophils. Sci Transl Med. 2020;12:eabb5817. doi: 10.1126/scitranslm ed.abb5817. Xu HJ, Ma Y, Deng F, Ju WB, Sun XY, Wang H. The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis. Onco Targets. 2017;10:3059-70. doi: 10.2147/OTT.S137002. Kaplan M, Ates I, Akpinar MY, Yuksel M, Kuzu UB, Kacar S, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017;16:424-30. doi: 10.1016/S1499-3872(17)60007-9 Winter JM, Cameron JL, Yeo CJ, Alao B, Lillemoe KD, Campbell KA, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg. 2007;204:1029-36. doi: 10.1016/j.jamcollsurg.2007.01.026 Yin M, Si L, Qin W, Li C, Zhang J, Yang H, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med. 2018;33:687-94. doi: 10.1177/0885066616685300 Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124. doi:10.1093/jnci/dju124. Sakamoto T, Yagyu Y, Uchinaka E, Morimoto M, Hanaki T, Tokuyasu N, et al. Predictive significance of C-reactive protein-to-albumin ratio for postoperative pancreatic fistula after pancreaticoduodenectomy. Anticancer Res. 2019;39:6283–90. doi: 10.21873/anticanres.13838 De Ulíbarri JI, González-Madroño A, de Villar NG, González P, González B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38-45. Taniguchi E, Kawaguchi T, Otsuka M, Uchida Y, Nagamatsu A, Itou M, et al. Nutritional assessments for ordinary medical care in patients with chronic liver disease. Hepatol Res. 2013;43:192-9. doi: 10.1111/j.1872-034X.2012.01055.x. Takagi K, Yagi T, Umeda Y, Shinoura S, Yoshida R, Nobuoka D, et al. Preoperative controlling nutritional status (CONUT) score for assessment of prognosis following hepatectomy for hepatocellular carcinoma. World J Surg. 2017;41:2353-60. doi: 10.1007/s00268-017-3985-8. Tables Table 1. Types of postoperative complications following highly advanced liver and pancreatic surgery Types of postoperative complications All (n=328) Pancreatic surgery (n=226) Liver surgery (n=102) p-value n (%) n (%) n (%) ▪Surgical site infection (surface) ▪Pneumonia ▪Urinary tract infection ▪Catheter infection ▪Intraabdominal abscess ▪Pulmonary embolism ▪Ileus ▪Pleural effusion ▪Pancreatic fistula ▪Bile leakage ▪Delayed gastric emptying ▪Postoperative hemorrhaging ▪Hepatic failure ▪Unplanned intubation ▪Reoperation within 30 days ▪Operative mortality 26 (7.9%) 14 (4.3%) 6 (1.8%) 9 (2.7%) 58 (17.7%) 13 (4.0%) 17 (5.2%) 56 (17.1%) 93 (28.4%) 33 (10.1%) 36 (11.0%) 28 (8.5%) 6 (1.8%) 10 (3.0%) 10 (3.0%) 8 (2.4%) 19 (8.4%) 13 (5.8%) 4 (1.8%) 6 (2.7%) 38 (16.8%) 10 (4.4%) 8 (3.5%) 21 (9.3%) 92 (40.7%) 4 (1.8%) 34 (15.0%) 22 (9.7%) 0 (0.0%) 6 (2.7%) 6 (2.7%) 4 (1.8%) 7 (6.9%) 1 (1.0%) 2 (2.0%) 3 (2.9%) 20 (19.6%) 3 (2.9%) 9 (8.8%) 35 (34.3%) 1 (1.0%) 29 (28.4%) 2 (2.0%) 6 (5.9%) 6 (5.9%) 4 (3.9%) 4 (3.9%) 4 (3.9%) 0.63 0.048* 0.91 0.88 0.54 0.51 0.046* < 0.001*** < 0.001*** < 0.001*** < 0.001*** 0.25 < 0.001*** 0.54 0.54 0.24 *: p< 0.05 **: p< 0.01 ***: p< 0.001 Table 2. Postoperative complication rates according to highly advanced liver and pancreatic surgery type n No complication cases Cases with non-PSC (CD grade <Ⅲ) Cases with PSC (CD grade ≧Ⅲ) n rate (%) n rate (%) n rate (%) Liver surgeries 309 207 66.9 53 17.2 49 15.9 ▪hepatic trisegmentectomy ▪hemihepatectomy ▪hepatic sectionectomy ▪hepatic segmentectomy 8 125 116 60 4 82 76 45 50.0 65.6 65.5 75.0 0 25 19 9 0.0 20.0 16.4 15.0 4 18 21 6 50.0 14.4 18.1 10.0 Pancreatic surgeries 366 140 38.3 108 29.5 118 32.2 ▪total pancreatectomy ▪pancreatico duodectomy ▪left pancreatectomy with lymph node dissection ▪middle pancreatectomy 18 268 76 4 12 85 42 1 66.7 31.7 55.3 25.0 2 89 16 1 11.1 33.2 21.1 25.0 4 94 18 2 22.2 35.1 23.7 50.0 Total 675 347 51.4 161 23.9 167 24.7 PSC: postoperative severe complicatons CD: clavien-dindo classification Table 3. Uni- and multivariate analysis to predict PSC following major pancreatic surgery n Univariate Multivariate OR 95%CI p-value OR 95%CI p -value Age (years) >75 22 <22 107 119 1.79 1 1.06-3.05 0.03* 1.91 0.76-3.53 0.20 ASA 3 1/2 27 119 1.65 1 0.73-3.90 0.23 Smoking Yes No 115 93 1.92 1 1.11-3.35 0.02* 1.91 0.85-4.36 0.12 Past abdominal surgery Yes No 85 141 1.32 1 0.77-2.27 0.32 Preoperative-chemotherapy Yes No 44 182 1.12 1 0.58-2.19 0.73 PNI >45 <45 151 75 0.86 1 0.49-1.50 0.60 CONUT Abnormal (≧2) Normal (0.03 5 300 <300 16 207 1.56 1 0.56-4.72 0.40 Charlson comorbidity index 2+ 0/1 97 129 1.59 1 0.94-2.74 0.09 1.16 0.45-3.01 0.75 History of malignancy Yes No 53 172 2.09 1 1.11-4.03 0.02* 2.39 0.79-7.43 0.12 Heart-related comorbidity Yes No 51 175 1.27 1 0.68-2.40 0.45 Respiratory-related Comorbidity Yes No 27 199 2.40 1 1.03-6.05 0.04* 1.75 0.48-7.21 1.75 Liver-related Comorbidity Yes No 17 209 0.62 1 0.27-1.67 0.34 Cerebrovascular-related Comorbidity Yes No 21 205 1.25 1 0.51-3.17 0.63 Diabetes mellitus Yes No 84 142 0.75 1 0.43-1.28 0.29 Chronic renal dysfunction Yes No 53 173 1.26 1 0.68-2.36 0.46 Pancreatoenteric anastomosis Yes (PD+MP) No (TP+LP) 186 40 0.87 1 0.44-1.73 0.70 Multiple organ resection Yes No 28 198 0.55 1 0.24-1.22 0.14 Operative time (min) >540 1000 7 20 10000 5.0 <5.0 127 99 4.39 1 2.53-7.78 < 0.001*** 4.27 2.05-9.13 10 <10 100 83 2.53 1 1.40-4.66 300 <300 53 130 2.61 1 1.33-5.33 < 0.01 1.54 0.61-4.02 0.36 PSC: postoperative severe complications OR: odds ratio 95%CI: 95% confidence interval BMI: body mass index ASA: American Society of Anesthesiologists physical status classification PNI: Prognostic nutritional index=10×albumin(g/dl) + 0.005× the absolute lymphocyte count CONUT: Controlling Nutritional Status PD: Pancreaticoduodenectomy MP: Middle pancreatectomy TP: Total pancreatectomy LP: left pancreatectomy with lymph node dissection CAR: C-reactive protein to albumin ratio NLR: Neutrophil to lymphocyte ratio PLR: Platelet to lymphocyte ratio POD: Postoperative day *: p< 0.05 **: p< 0.01 ***: p75 22 <22 50 52 0.62 1 0.28-1.35 0.23 ASA 3 1/2 13 89 0.92 1 0.28-2.97 0.88 Smoking Yes No 59 26 0.90 1 0.36-2.29 0.90 Past abdominal surgery Yes No 49 53 1.26 1 0.58-2.76 0.57 Preoperative-chemotherapy Yes No 32 70 0.54 1 0.22-1.25 0.15 PNI >45 <45 42 60 0.74 1 0.36-1.64 0.46 CONUTS Abnormal (≧2) Normal (< 1) 68 32 2.42 1 1.03-5.94 0.04* 3.40 1 1.37-8.81 0.03 5 300 <300 2 100 1.08 1 0.04-27.88 0.96 Charlson comorbidity index 2+ 0/1 26 76 0.59 1 0.24-1.45 0.25 History of malignancy Yes No 47 55 0.92 1 0.42-1.99 0.82 Heart-related comorbidity Yes No 16 86 3.29 1 1.05-12.51 0.04* 3.52 1 0.93-15.16 0.06 Respiratory-related Comorbidity Yes No 17 85 1.27 1 0.44-3.67 0.66 Liver-related Comorbidity Yes No 40 62 1.34 1 0.60-3.00 0.47 Cerebrovascular-related Comorbidity Yes No 7 95 6.13 1 1.00-118.02 0.05 4.05 1 0.53-84.21 0.19 Diabetes mellitus Yes No 35 67 1.22 1 0.54-2.80 0.62 Chronic renal dysfunction Yes No 25 77 1.23 1 0.50-3.08 0.65 Type of surgery Tri/Hemi Sec/Seg 46 56 1.19 1 0.54-2.62 0.66 Multiple organ resection Yes No 24 78 0.89 1 0.35-2.23 0.80 Operative time (min) >540 1000 7 20 10000 5.0 10 300 <300 9 68 0.75 1 0.17-3.09 0.70 SC: severe complications OR: odds ratio 95%CI: 95% confidence interval BMI: body mass index ASA: American Society of Anesthesiologists physical status classification PNI: Prognostic nutritional index=10×albumin(g/dl) + 0.005× the absolute lymphocyte count CONUTS: Controlling Nutritional Status Score Tri: Trisegmentectomy Hemi: Hemihepatectomy Sec: Sectionectomy Seg: Segmentectomy CAR: C-reactive protein to albumin ratio NLR: Neutrophil to lymphocyte ratio PLR: Platelet to lymphocyte ratio POD: Postoperative day *: p< 0.05 **: p< 0.01 ***: p< 0.001 Additional Declarations No competing interests reported. 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07:10:38","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":171527,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7493031/v1/a49ae0d8577d6550c486a6ed.html"},{"id":92474237,"identity":"c91a1b64-3399-4f00-8ae7-94df241814ab","added_by":"auto","created_at":"2025-09-30 07:10:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67146,"visible":true,"origin":"","legend":"\u003cp\u003eExclusion criteria used in the study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7493031/v1/7fbfdd036cd88bff4099a4de.png"},{"id":95119004,"identity":"4c2f101d-4a1e-4fa9-8dd7-1d084942648a","added_by":"auto","created_at":"2025-11-04 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retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eSurgery is an effective treatment approach for malignant diseases, thereby improving patient prognosis. However, postoperative complications can be severe and life-threatening. Among the many types of abdominal surgery, major liver and pancreatic surgeries require advanced techniques and are associated with high postoperative complications and mortality rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. To monitor surgical safety in Japan, the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) established systems for the board certification of training institutions in 2008 and expert surgeons in 2011. As of July 2024, 653 JSHBPS-certified expert surgeons perform advanced hepatobiliary pancreatic surgery (HBPS) at 307 training institutions nationwide. These efforts have contributed to better postoperative outcomes in Japan than in other countries [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Owing to these systems, the postoperative mortality rates of highly advanced HBPS for all board-certified institutions decreased from 2012 to 2019 (30-day: 0.92\u0026ndash;0.52% and 90-day: 2.1\u0026ndash;0.98%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Gifu University Hospital is board-certified, and we reported a 90-day postoperative mortality rate of 1.3%, comparable to that of other board-certified institutions, as well as the results of a mortality risk factor analysis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although preventing surgery-related mortality is crucial, preventing severe postoperative complications associated with major liver and pancreatic surgeries is essential. Addressing this issue is vital for ensuring the smooth introduction of postoperative adjuvant treatment and reducing medical costs.\u003c/p\u003e\u003cp\u003eHowever, HBP surgeons are generally required to have the ability to perform and manage both liver and pancreatic surgery, which are different in nature, in clinical practice. Therefore, it is important for HBP surgeons to have a comprehensive understanding of both liver and pancreatic surgery.\u003c/p\u003e\u003cp\u003eThus, this study aimed to identify perioperative (preoperative, intraoperative, and postoperative) predictive factors for postoperative severe complications (PSC) following each major liver and pancreatic surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design and setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study retrospectively analyzed 675 patients who underwent major liver and pancreatic surgeries at Gifu University Hospital, a certified training facility by JSHBPS, from January 2010 to December 2023. All highly level HBPS procedures were performed by experienced board-certified, JSHBPS-qualified surgeons. The study aimed to determine perioperative predictors of PSC following major liver and pancreatic surgery.\u003c/p\u003e\n\u003cp\u003eApproval was granted by the Gifu University Ethics Committee (approval no. 2023-018). In line with the Declaration of Helsinki, informed consent was waived due to the study\u0026rsquo;s retrospective design.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDefinition of severe postoperative complications\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was PSC following major liver and pancreatic surgery, defined as a postoperative complication of grade \u0026ge;III (requiring radiologic intervention or reoperation) using the Clavien\u0026ndash;Dindo (CD) classification. Non-PSC was defined as a postoperative complication of grade II (requiring antibiotic therapy) or grade I (resolved without treatment) using the CD classification.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePreoperative, intraoperative, and postoperative variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe examined a comprehensive range of variables spanning the preoperative, intraoperative, and postoperative periods. Preoperative parameters encompassed demographic and clinical characteristics (e.g., age, sex, BMI, ASA classification, smoking status, prior abdominal surgery, preoperative chemotherapy), nutritional and inflammatory indices (PNI, CONUT, CAR, NLR, PLR), and comorbidities (Charlson comorbidity index and types of comorbid conditions). Intraoperative factors included type of surgery, additional organ resections, operative time, intraoperative blood loss, and transfusion requirements. Postoperative data comprised date of complication diagnosis, arterial lactate levels on postoperative day (POD) 1, and inflammatory markers on POD 3.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMajor liver and pancreatic surgery\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMajor liver surgeries include hepatic trisegmentectomy, hemihepatectomy, hepatic sectionectomy (except lateral sectionectomy), and hepatic segmentectomy (S1, S2, S3, S5, S6, S7, S8). Additionally, pancreatic surgeries include total pancreatectomy, pancreaticoduodenectomy (PD), left pancreatectomy with lymph node dissection, and middle segment pancreatectomy (MP). This study excluded hepatobiliary surgeries involving biliary resection and reconstruction, such as hepatectomy with extrahepatic bile duct resection, extrahepatic bile duct resection for congenital biliary dilatation, and hepatopancreatectomy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt our institution, the surgical indications for major hepatectomy typically include (i) Child-Pugh classification grade A and (ii) a scheduled residual liver indocyanine green (ICG) disappearance rate, calculated as ([ICG disappearance rate] \u0026times; [ratio of expected residual liver volume to total liver volume]) \u0026gt; 0.05. Liver volume was calculated using SYNAPSE VINCENT (Fujifilm Medical Co., Ltd., Tokyo, Japan) based on preoperative contrast-enhanced computed tomography images. Additionally, all patients underwent a preoperative consultation with an anesthesiologist for surgical clearance.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analyses\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData presentation adhered to standard conventions, with continuous variables expressed as medians (range) and categorical variables as counts (percentages). Between-group comparisons employed Fisher\u0026rsquo;s exact and Mann\u0026ndash;Whitney U tests. Optimal thresholds for ROC analysis were determined via Youden\u0026rsquo;s index. Variables yielding p \u0026lt; 0.10 in univariate models were included in multivariate logistic regression. Statistical significance was defined as p \u0026lt; 0.05 (two-tailed). All analyses were conducted using JMP software (SAS Institute Inc., Cary, NC, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 675 patients who underwent major liver or pancreatic surgeries. We excluded 347 (51.4%) patients who did not experience postoperative complications. In total, 328 (48.6%) patients who experienced at least one postoperative complication of CD grade \u0026ge; I were evaluated for risk factors associated with PSC. According to the CD grading system, 53 (52.0%) patients had non-PSC, and 49 (48.0%) had PSC after major liver surgery, and 108 (47.8%%) patients had non-PSC, and 118 (52.2%) had PSC after major pancreatic surgery \u0026nbsp;(\u003cstrong\u003eFigure 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTypes of postoperative complications following major liver and pancreatic surgery\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e summarizes the types of postoperative complications after major liver and pancreatic surgeries. Significant differences were found in type-specific surgical complications, such as pancreatic fistula, delayed gastric emptying, bile leakage, and hepatic failure (all p\u0026lt;0.001). Regarding nonspecific surgical complications, pneumonia was significantly more common in pancreatic surgery (p=0.048), whereas ileus and pleural effusion were more frequent in liver surgery (p=0.046 and p\u0026lt;0.001, respectively). Other non-specific surgical complications and postoperative hemorrhage, reoperation, and operative mortality did not differ significantly between liver and pancreatic surgeries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003cem\u003eostoperative complication rates\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eaccording to major liver and pancreatic surgery type\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e summarizes the postoperative complication rates according to the type of major liver and pancreatic surgeries. Regarding hepatectomy, a trend towards an increased incidence of postoperative complications with more extensive resection was observed. When patients who underwent hepatic trisegmentectomy were excluded, the rates of PSC and non-PSC were similar (15.9% and 17.2%, respectively). Conversely, in pancreatic surgery, postoperative complications appeared to increase with procedures involving pancreatoenteric anastomosis (PD and MP). Compared with hepatectomy, the incidence of postoperative complications was higher; however, the rates of PSC and non-PSC after pancreatic surgery were similar (32.2% and 29.5%, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eComparison of patient characteristics between\u0026nbsp;\u003c/em\u003e\u003cem\u003eP\u003c/em\u003e\u003cem\u003eSC and non-\u003c/em\u003e\u003cem\u003eP\u003c/em\u003e\u003cem\u003eSC groups\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplemental\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e compares patient characteristics between the PSC and non-PSC groups. Patients in the PSC group had significantly longer hospital stays (p\u0026lt;0.001) than those in the non-PSC group. Additionally, the PSC group was more likely to be male (p=0.06), have a history of smoking (p=0.07), have an abnormal CONUT score (\u0026ge;2, p=0.08), and have a higher rate of respiratory-related comorbidities (p=0.07) than the non-PSC group. No significant differences were observed in the intraoperative variables between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnivariate and multivariate analyses to predict PSC in patients following major pancreatic surgery\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the univariate analysis, PSC after major pancreatic surgery was significantly associated with male sex (p=0.01), higher BMI (p=0.03), history of smoking (p=0.02), history of malignancy (p=0.02), respiratory-related comorbidity (p=0.04), and CAR, NLR, and PLR on POD3 (p\u0026lt;0.001, p\u0026lt;0.01, and p\u0026lt;0.01, respectively). Additionally, a higher Charlson Comorbidity Index (p=0.09) showed a significant association. Conversely, intraoperative factors, including the presence of pancreatic-enteric anastomosis (PD and MP), showed no significant differences.\u003c/p\u003e\n\u003cp\u003eFinally, in the multivariate analysis, only CAR on POD3 (\u0026gt;5.0, OR, 4.27; 95% CI, 2.05\u0026ndash;9.13; p\u0026lt;0.001) was an independent predictive factor for PSC after major pancreatic surgery (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnivariate and multivariate analyses to predict P\u003c/em\u003e\u003cem\u003eSC\u003c/em\u003e\u003cem\u003e\u0026nbsp;in patients\u003c/em\u003e\u003cem\u003e\u0026nbsp;following\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003emajor\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eliver surgery\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the univariate analysis, PSC after major liver surgery was significantly associated with an abnormal CONUT score (p=0.04) and heart-related comorbidities (p=0.04). Additionally, cerebrovascular comorbidities showed a significant trend (p=0.05). However, intraoperative factors, including extensive liver resection (trisegmentectomy and hemihepatectomy) and postoperative-related factors, did not show significant differences.\u003c/p\u003e\n\u003cp\u003eFinally, in the multivariate analysis, only an abnormal CONUT score (OR, 3.40; 95% CI, 1.37\u0026ndash;8.81; p\u0026lt;0.01) was an independent predictive factor for PSC following major liver surgery (\u003cstrong\u003eTable 4).\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated perioperative predictive factors for severe postoperative complications after major liver and pancreatic surgeries. PSC rates at our institution were 15.9% after major hepatectomy and 32.2% after major pancreatectomy, with PD accounting for 35.0% of the cases. According to the 2021 National Clinical Database report in Japan, PSC rates in board-certified training institutions were 23.5% after major hepatectomy and 39.7% after PD [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The postoperative outcomes in this study were comparable to those of other board-certified training institutions. Therefore, facilitating the recognition of the signs of severe complications is necessary to improve postoperative outcomes.\u003c/p\u003e\u003cp\u003eFirst, the severity of postoperative complications increases the direct burden on patients by requiring invasive treatment such as radiological intervention or reoperation. Additionally, it increases postoperative hospital stay. In this study, PSC was associated with a longer hospital stay for both liver and pancreatic surgeries (liver surgery: PSC vs. non-PSC, 35 vs. 19 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; pancreatic surgery: PSC vs. non-PSC, 42 vs. 27 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Thus, prolonged hospital stay caused by PSC increases patient burden and medical costs and may negatively impact postoperative treatment [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Matsuda et al. reported that infectious postoperative complications diminished the effectiveness of adjuvant chemotherapy and induced impaired oncological outcomes in a multicenter retrospective cohort study involving 1817 patients with curative-stage colorectal cancer [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. For pancreatic and cholangiocarcinoma cancers requiring postoperative adjuvant chemotherapy, Macfie et al. reported that patients who experienced PSC had lower rates of adjuvant therapy and worse recurrence-free survival [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Notably, adjuvant chemotherapy complication rates after major pancreatectomy still result in a high morbidity rate [\u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], with recent prospective randomized trials showing only 40\u0026ndash;63% of patients completing all planned therapies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These studies suggest that the negative impact of PSC on postoperative adjuvant therapy is high and leads to a worse long-term prognosis. Additionally, PSC may directly impair survival by producing and activating inflammatory cytokines that promote micrometastasis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. PSCs induce high levels of hepatocyte growth factors and stress-induced oxidized lipids, promoting metastasis and tumor progression [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In summary, preventing PSC may improve long-term prognosis from the following perspectives: i) smooth introduction of adjuvant chemotherapy and ii) suppression of local and systemic postoperative inflammation.\u003c/p\u003e\u003cp\u003eSecond, this study revealed that abnormally high levels of postoperative inflammatory markers may be independent predictive factors for PSC after major pancreatic surgeries. Additionally, whereas preoperative factors, such as male sex, high BMI, smoking history, comorbidities, and CONUT score, significantly correlated with PSC in the univariate analyses, no significant differences were found for intraoperative factors. We hypothesize that this result is because of the following factors: (i) complications following major pancreatectomy include a higher frequency of infectious complications, such as pancreatic fistula and pneumonia, (ii) surgeries were performed using standardized procedures by board-certified surgeons at a single certified training institution, and (iii) strictly-defined surgical indications, particularly for major liver surgery.\u003c/p\u003e\u003cp\u003eThe analysis identified the CAR on POD3 as an independent predictor of PSC after major pancreatic surgery. CAR is a novel inflammatory marker that has demonstrated prognostic value in various inflammatory and malignant conditions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It reflects the systemic inflammatory response by combining CRP, a positive acute-phase protein, and albumin, a negative acute-phase reactant whose serum concentration decreases as inflammation worsens [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Consequently, CAR serves as a dynamic, individualized indicator of acute-phase inflammatory intensity. A well-documented correlation exists between systemic inflammation and the severity of postoperative complications [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Recently, Sakamoto et al. reported that CAR on POD3 is a reliable marker for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy, with an optimal cutoff of 7.4 based on receiver operating characteristic (ROC) analysis [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This value is close to the threshold identified in our study (5.0), underscoring CAR\u0026rsquo;s potential as a practical and accessible tool for early risk stratification in major pancreatic surgery.\u003c/p\u003e\u003cp\u003eThis study found that preoperative nutritional assessment using the CONUT score was an independent predictor of complication severity after major hepatectomy. The CONUT score, developed as a nutritional screening tool, is calculated based on serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. A higher score indicates severe malnutrition. The CONUT score, similar to the PNI, is a useful and simple method for assessing nutritional status. However, the CONUT score has a stronger association with anthropometric values than the PNI score, which was associated with hepatic function [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Takagi et al. reported that a preoperative high CONUT score (\u0026ge;\u0026thinsp;3) is associated with worse hepatic functional reserve and a higher incidence of major postoperative complications in patients with hepatocellular carcinoma [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, this study revealed that an abnormal CONUT score was a better predictor of complication severity following major liver surgery than the PNI. Therefore, a safer major hepatectomy may be achieved by adding the CONUT score to the conventional Child-Pugh classification for liver function assessment. Preoperative nutritional enhancement interventions may help reduce the risk of developing severe diseases.\u003c/p\u003e\u003cp\u003eSeveral limitations merit consideration. This retrospective, single-center design may inherently limit generalizability due to potential selection bias and analytical multiplicity. Although multicenter trials offer broader applicability, inter-institutional variability may confound results. Hence, this study\u0026mdash;conducted in a single, highly standardized medical environment\u0026mdash;may still offer valuable insight. Additionally, while POD3 inflammatory markers were evaluated, the ideal time point and threshold require further validation. These caveats should inform interpretation.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn patients with postoperative complications after major pancreatic surgery, inflammatory markers may be early predictive factors of severity. Additionally, this study identified an abnormal CONUT score as an independent predictor of major liver surgery. The results highlight the value of early, inflammation-based postoperative management after major pancreatic surgery, and suggest that enhancing preoperative nutrition prior to major hepatectomy may shorten postoperative hospital stays and improve outcomes following major liver and pancreatic surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eJSHBPS, Japanese Society of Hepato-Biliary-Pancreatic Surgery; HBPS, hepatobiliary-pancreatic surgery; PSC, Postoperative severe complication; CD, Clavien\u0026ndash;Dindo; BMI, body mass index; PNI, Prognostic nutritional index; CONUT, controlling nutritional status; CAR, C-reactive protein to albumin ratio; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; POD, postoperative day; PD, pancreaticoduodenectomy; MP, middle pancreatectomy; ICG, indocyanine green; OR, odds ratio; CI, confidence interval; CR-POPF, clinically relevant postoperative pancreatic fistula\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the World Medical Association Declaration of Helsinki and approved by the Ethics Committee of Gifu University (approval number: 2023-018). This retrospective study did not include any potentially identifiable patient data; therefore, the need for informed consent was waived by the Ethics Committee of Gifu University. This retrospective study was approved by the Institutional Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eMF conceived the study concept, planned the study design as the principal investigator, interpreted the results, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eNM revised the manuscript, added intellectual content, and provided critical advice. MF,\u0026nbsp;NM,\u0026nbsp;TH, IY, YS, JYT, YT, and NM obtained the data, provided critical comments to improve the manuscript, and approved its final submission. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors thank the medical staff of the Department of Gastroenterological Surgery at Gifu University Hospital for their participation in this study. We could not have completed this study without their diligence or support. We would like to thank Editage (www.editage.jp) for the English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCsikesz NG, Simons JP, Tseng JF, Shah SA. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg. 2008;12:1534-9. doi: 10.1007/s11605-008-0566-z\u003c/li\u003e\n\u003cli\u003eAloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB. 2009;11:510-5. doi: 10.1111/j.1477-2574.2009.00095.x\u003c/li\u003e\n\u003cli\u003eVirani S, Michaelson JS, Hutter MM, Lancaster RT, Warshaw AL, Henderson WG, et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg. 2007;204:1284-92. doi: 10.1016/j.jamcollsurg.2007.02.067\u003c/li\u003e\n\u003cli\u003eTzeng CW, Cooper AB, Vauthey JN, Curley SA, Aloia TA. Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients. HPB. 2014;16:459-68. doi: 10.1111/hpb.12155\u003c/li\u003e\n\u003cli\u003eMadhavan S, Shelat VG, Soong SL, Woon WWL, Huey T, Chan YH, et al. Predicting morbidity of liver resection. Langenbeck\u0026apos;s Arch Surg. 2018;403:359-69. doi: 10.1007/s00423-018-1656-3\u003c/li\u003e\n\u003cli\u003eKhaoudy I, Farges O, Boleslawski E, Vibert E, Soubrane O, Adham M, et al. Half of postoperative deaths after hepatectomy may be preventable: a root-cause analysis of a prospective multicenter cohort study. Ann Surg. 2018;268:792-8. doi: 10.1097/SLA.0000000000002837\u003c/li\u003e\n\u003cli\u003eWiggers JK, Koerkamp BG, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, et al. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg. 2016;223:321-31. doi: 10.1016/j.jamcollsurg.2016.03.035\u003c/li\u003e\n\u003cli\u003eLaunois B, Reding R, Lebeau G, Buard JL. Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepatobiliary Pancreat Surg. 2000;7:128-34. doi: 10.1007/s005340050166\u003c/li\u003e\n\u003cli\u003eNuzzo G, Giuliante F, Ardito F, Giovannini I, Aldrighetti L, Belli G, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg. 2012;147:26-34. doi: 10.1001/archsurg.2011.771\u003c/li\u003e\n\u003cli\u003eGlasgow RE, Jackson HH, Neumayer L, Schifftner TL, Khuri SF, Henderson WG, et al. Pancreatic resection in Veterans Affairs and selected university medical centers: results of the patient Safety in surgery study. J Am Coll Surg. 2007;204:1252-60. doi: 10.1016/j.jamcollsurg.2007.03.015\u003c/li\u003e\n\u003cli\u003eWegner RE, Verma V, Hasan S, Schiffman S, Thakkar S, Horne ZD, et al. Incidence and risk factors for post-operative mortality, hospitalization, and readmission rates following pancreatic cancer resection. J Gastrointest Oncol. 2019;10:1080-93. doi: 10.21037/jgo.2019.09.01\u003c/li\u003e\n\u003cli\u003eOtsubo T, Kobayashi S, Sano K, Misawa T, Katagiri S, Nakayama H, et al. A nationwide certification system to increase the safety of highly advanced hepatobiliary-pancreatic surgery. J Hepatobiliary Pancreat Sci. 2023;30:60-71. doi: 10.1002/jhbp.1186.\u003c/li\u003e\n\u003cli\u003eFukada M, Murase K, Higashi T, Yasufuku I, Sato Y, Tajima JY, et al. Perioperative predictive factors of failure to rescue following highly advanced hepatobiliary-pancreatic surgery: a single-institution retrospective study. World J Surg Oncol. 2023;21:365. doi: 10.1186/s12957-023-03257-6. \u003c/li\u003e\n\u003cli\u003eEndo I, Hirahara N, Miyata H, Yamamoto H, Matsuyama R, Kumamoto T, et al. Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: an analysis of patients registered in the National Clinical Database in Japan. J Hepatobiliary Pancreat Sci. 2021;28:305-16. doi: 10.1002/jhbp.918. \u003c/li\u003e\n\u003cli\u003eArtinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261:497-505. doi: 10.1097/SLA.0000000000000854\u003c/li\u003e\n\u003cli\u003eGoto S, Hasegawa S, Hida K, Uozumi R, Kanemitsu Y, Watanabe T, et al. Multicenter analysis of impact of anastomotic leakage on long-term oncologic outcomes after curative resection of colon cancer. Surgery. 2017;162:317-24. doi: 10.1016/j.surg.2017.03.005\u003c/li\u003e\n\u003cli\u003eMirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890-9. doi: 10.1097/SLA.0b013e3182128929\u003c/li\u003e\n\u003cli\u003eMatsuda A, Maruyama H, Akagi S, Inoue T, Uemura K, Kobayashi M, et al. Do postoperative infectious complications really affect long-term survival in colorectal cancer surgery? A multicenter retrospective cohort study. Ann Gastroenterol Surg. 2022;7:110-20. doi: 10.1002/ags3.12615.\u003c/li\u003e\n\u003cli\u003eMacfie R, Berger Y, Liu H, Li T, Imtiaz S, Ang C, et al. Major postoperative complications limit adjuvant therapy administration in patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma or pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2023;30:5027-34. doi: 10.1245/s10434-023-13533-0.\u003c/li\u003e\n\u003cli\u003eCameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530-6. doi: 10.1016/j.jamcollsurg.2014.12.031\u003c/li\u003e\n\u003cli\u003eVersteijne E, Sucher M, Groothuis K, Akkermans-Vogelaar JM, Besselink MG, Bonsing BA, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial. J Clin Oncol. 2020;38:1763-73. doi: 10.1200/JCO.19.02274.\u003c/li\u003e\n\u003cli\u003eWu W, He J, Cameron J, Makary M, Soares K, Ahuja N, et al. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol. 2014;21:2873-81. doi: 10.1245/s10434-014-3722-6.\u003c/li\u003e\n\u003cli\u003eConroy T, Desseingne F, Ychou M, Bouch\u0026eacute; O, Guimbaud R, B\u0026eacute;couarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817-25. doi: 10.1056/NEJMoa1011923.\u003c/li\u003e\n\u003cli\u003eNeoptolemos J, Palmer D, Ghana P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389:1011-24. doi: 10.1016/S0140-6736(16)32409-6.\u003c/li\u003e\n\u003cli\u003eNeoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308:147-56. doi: 10.1001/jama.2012.7352\u003c/li\u003e\n\u003cli\u003eSohal D, Duong MT, Ahmad SA, Gandhi N, Beg MS, Wang-Gillam A, et al. SWOG S1505: results of perioperative chemotherapy (peri-op CTx) with mfolfirinox versus gemcitabine/nab-paclitaxel (Gem/nabP) for resectable pancreatic ductal adenocarcinoma (PDA). J Clin Oncol. 2020;38:4504. doi: 10.1200/JCO.2020.38.15_suppl.4504.\u003c/li\u003e\n\u003cli\u003eBohle B, Pera M, Pascual M, Alonso S, Mayol X, Salvado M, et al. Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery. 2010;147:120-6. doi: 10.1016/j.surg.2009.06.035.\u003c/li\u003e\n\u003cli\u003eTsujimoto H, Horiguchi H, Matsumoto Y, Takahata R, Shinomiya N, Yamori T, et al. A potential mechanism of tumor progression during systemic infections via the hepatocyte growth factor (HGF)/c-Met signaling pathway. J Clin Med. 2020;9:2074. doi: 10.3390/jcm90 72074.\u003c/li\u003e\n\u003cli\u003ePerego M, Tyurin VA, Tyurina YY, Yellets J, Nacarelli T, Lin C, et al. Reactivation of dormant tumor cells by modified lipids derived from stress-activated neutrophils. Sci Transl Med. 2020;12:eabb5817. doi: 10.1126/scitranslm ed.abb5817.\u003c/li\u003e\n\u003cli\u003eXu HJ, Ma Y, Deng F, Ju WB, Sun XY, Wang H. The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis. Onco Targets. 2017;10:3059-70. doi: 10.2147/OTT.S137002.\u003c/li\u003e\n\u003cli\u003eKaplan M, Ates I, Akpinar MY, Yuksel M, Kuzu UB, Kacar S, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017;16:424-30. doi: 10.1016/S1499-3872(17)60007-9\u003c/li\u003e\n\u003cli\u003eWinter JM, Cameron JL, Yeo CJ, Alao B, Lillemoe KD, Campbell KA, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg. 2007;204:1029-36. doi: 10.1016/j.jamcollsurg.2007.01.026\u003c/li\u003e\n\u003cli\u003eYin M, Si L, Qin W, Li C, Zhang J, Yang H, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med. 2018;33:687-94. doi: 10.1177/0885066616685300\u003c/li\u003e\n\u003cli\u003eTempleton AJ, McNamara MG, \u0026Scaron;eruga B, Vera-Badillo FE, Aneja P, Oca\u0026ntilde;a A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124. doi:10.1093/jnci/dju124.\u003c/li\u003e\n\u003cli\u003eSakamoto T, Yagyu Y, Uchinaka E, Morimoto M, Hanaki T, Tokuyasu N, et al. Predictive significance of C-reactive protein-to-albumin ratio for postoperative pancreatic fistula after pancreaticoduodenectomy. Anticancer Res. 2019;39:6283\u0026ndash;90. doi: 10.21873/anticanres.13838\u003c/li\u003e\n\u003cli\u003eDe Ul\u0026iacute;barri JI, Gonz\u0026aacute;lez-Madro\u0026ntilde;o A, de Villar NG, Gonz\u0026aacute;lez P, Gonz\u0026aacute;lez B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38-45. \u003c/li\u003e\n\u003cli\u003eTaniguchi E, Kawaguchi T, Otsuka M, Uchida Y, Nagamatsu A, Itou M, et al. Nutritional assessments for ordinary medical care in patients with chronic liver disease. Hepatol Res. 2013;43:192-9. doi: 10.1111/j.1872-034X.2012.01055.x.\u003c/li\u003e\n\u003cli\u003eTakagi K, Yagi T, Umeda Y, Shinoura S, Yoshida R, Nobuoka D, et al. Preoperative controlling nutritional status (CONUT) score for assessment of prognosis following hepatectomy for hepatocellular carcinoma. World J Surg. 2017;41:2353-60. doi: 10.1007/s00268-017-3985-8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Types of postoperative complications following highly advanced liver and pancreatic surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eTypes of postoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eAll (n=328)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003ePancreatic surgery (n=226)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eLiver surgery (n=102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003en (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e▪Surgical site infection (surface)\u003c/p\u003e\n \u003cp\u003e▪Pneumonia\u003c/p\u003e\n \u003cp\u003e▪Urinary tract infection\u003c/p\u003e\n \u003cp\u003e▪Catheter infection\u003c/p\u003e\n \u003cp\u003e▪Intraabdominal abscess\u003c/p\u003e\n \u003cp\u003e▪Pulmonary embolism\u003c/p\u003e\n \u003cp\u003e▪Ileus\u003c/p\u003e\n \u003cp\u003e▪Pleural effusion\u003c/p\u003e\n \u003cp\u003e▪Pancreatic fistula\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e▪Bile leakage\u003c/p\u003e\n \u003cp\u003e▪Delayed gastric emptying\u003c/p\u003e\n \u003cp\u003e▪Postoperative hemorrhaging\u003c/p\u003e\n \u003cp\u003e▪Hepatic failure\u003c/p\u003e\n \u003cp\u003e▪Unplanned intubation\u003c/p\u003e\n \u003cp\u003e▪Reoperation within 30 days\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e▪Operative mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e26 (7.9%)\u003c/p\u003e\n \u003cp\u003e14 (4.3%)\u003c/p\u003e\n \u003cp\u003e6 (1.8%)\u003c/p\u003e\n \u003cp\u003e9 (2.7%)\u003c/p\u003e\n \u003cp\u003e58 (17.7%)\u003c/p\u003e\n \u003cp\u003e13 (4.0%)\u003c/p\u003e\n \u003cp\u003e17 (5.2%)\u003c/p\u003e\n \u003cp\u003e56 (17.1%)\u003c/p\u003e\n \u003cp\u003e93 (28.4%)\u003c/p\u003e\n \u003cp\u003e33 (10.1%)\u003c/p\u003e\n \u003cp\u003e36 (11.0%)\u003c/p\u003e\n \u003cp\u003e28 (8.5%)\u003c/p\u003e\n \u003cp\u003e6 (1.8%)\u003c/p\u003e\n \u003cp\u003e10 (3.0%)\u003c/p\u003e\n \u003cp\u003e10 (3.0%)\u003c/p\u003e\n \u003cp\u003e8 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e19 (8.4%)\u003c/p\u003e\n \u003cp\u003e13 (5.8%)\u003c/p\u003e\n \u003cp\u003e4 (1.8%)\u003c/p\u003e\n \u003cp\u003e6 (2.7%)\u003c/p\u003e\n \u003cp\u003e38 (16.8%)\u003c/p\u003e\n \u003cp\u003e10 (4.4%)\u003c/p\u003e\n \u003cp\u003e8 (3.5%)\u003c/p\u003e\n \u003cp\u003e21 (9.3%)\u003c/p\u003e\n \u003cp\u003e92 (40.7%)\u003c/p\u003e\n \u003cp\u003e4 (1.8%)\u003c/p\u003e\n \u003cp\u003e34 (15.0%)\u003c/p\u003e\n \u003cp\u003e22 (9.7%)\u003c/p\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003cp\u003e6 (2.7%)\u003c/p\u003e\n \u003cp\u003e6 (2.7%)\u003c/p\u003e\n \u003cp\u003e4 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e7 (6.9%)\u003c/p\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003cp\u003e20 (19.6%)\u003c/p\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003cp\u003e9 (8.8%)\u003c/p\u003e\n \u003cp\u003e35 (34.3%)\u003c/p\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003cp\u003e29 (28.4%)\u003c/p\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003cp\u003e6 (5.9%)\u003c/p\u003e\n \u003cp\u003e6 (5.9%)\u003c/p\u003e\n \u003cp\u003e4 (3.9%)\u003c/p\u003e\n \u003cp\u003e4 (3.9%)\u003c/p\u003e\n \u003cp\u003e4 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003cp\u003e0.048*\u003c/p\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003cp\u003e0.046*\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;*: p\u0026lt; 0.05 **: p\u0026lt; 0.01 ***: p\u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Postoperative complication rates according to highly advanced liver and pancreatic surgery type\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNo complication cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003eCases with non-PSC\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(CD grade \u0026lt;Ⅲ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003eCases with PSC\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(CD grade\u0026nbsp;≧Ⅲ)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003erate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003erate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003erate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eLiver surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e▪hepatic trisegmentectomy\u003c/p\u003e\n \u003cp\u003e▪hemihepatectomy\u003c/p\u003e\n \u003cp\u003e▪hepatic sectionectomy\u003c/p\u003e\n \u003cp\u003e▪hepatic segmentectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003cp\u003e65.6\u003c/p\u003e\n \u003cp\u003e65.5\u003c/p\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003ePancreatic surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e▪total pancreatectomy\u003c/p\u003e\n \u003cp\u003e▪pancreatico duodectomy\u003c/p\u003e\n \u003cp\u003e▪left pancreatectomy with lymph node dissection\u003c/p\u003e\n \u003cp\u003e▪middle pancreatectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003cp\u003e55.3\u003c/p\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePSC: postoperative severe complicatons\u003c/p\u003e\n\u003cp\u003eCD: clavien-dindo classification\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Uni- and multivariate analysis to predict PSC following major pancreatic surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"20\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e\u0026gt;75\u003c/p\u003e\n \u003cp\u003e\u0026lt;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.64-1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.15-3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.40-2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026gt;22\u003c/p\u003e\n \u003cp\u003e\u0026lt;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.06-3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.76-3.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.73-3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.11-3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.85-4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePast abdominal surgery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.77-2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative-chemotherapy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.58-2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePNI\u003c/p\u003e\n \u003cp\u003e\u0026gt;45\u003c/p\u003e\n \u003cp\u003e\u0026lt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.49-1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCONUT\u003c/p\u003e\n \u003cp\u003eAbnormal (≧2)\u003c/p\u003e\n \u003cp\u003eNormal (\u0026lt; 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.74-2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative CAR\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.03\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.87-2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative NLR\u003c/p\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.57-7.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative PLR\u003c/p\u003e\n \u003cp\u003e\u0026gt;300\u003c/p\u003e\n \u003cp\u003e\u0026lt;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.56-4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003cp\u003e2+\u003c/p\u003e\n \u003cp\u003e0/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.94-2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.45-3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHistory of malignancy\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2.09\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.11-4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.79-7.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHeart-related comorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.68-2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eRespiratory-related\u003c/p\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.03-6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.48-7.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eLiver-related\u003c/p\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.27-1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCerebrovascular-related\u003c/p\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.51-3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.43-1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eChronic renal dysfunction\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.68-2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePancreatoenteric anastomosis\u003c/p\u003e\n \u003cp\u003eYes (PD+MP)\u003c/p\u003e\n \u003cp\u003eNo (TP+LP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.44-1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eMultiple organ resection\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.24-1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eOperative time (min)\u003c/p\u003e\n \u003cp\u003e\u0026gt;540\u003c/p\u003e\n \u003cp\u003e\u0026lt;540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.62-2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eBlood loss (ml)\u003c/p\u003e\n \u003cp\u003e\u0026gt;1000\u003c/p\u003e\n \u003cp\u003e\u0026lt;1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.72-2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eBlood transfusion\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.46-1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eDate of complication diagnosis (POD)\u003c/p\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.46-1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eArterial lactic acid level on POD1 (mg/dl)\u003c/p\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.61-2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eWhite blood cell on POD3 (\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u0026micro;l)\u003c/p\u003e\n \u003cp\u003e\u0026gt;10000\u003c/p\u003e\n \u003cp\u003e\u0026lt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.73-2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCAR on POD3\u003c/p\u003e\n \u003cp\u003e\u0026gt;5.0\u003c/p\u003e\n \u003cp\u003e\u0026lt;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4.39\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.53-7.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e4.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.05-9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eNLR on POD3\u003c/p\u003e\n \u003cp\u003e\u0026gt;10\u003c/p\u003e\n \u003cp\u003e\u0026lt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.40-4.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt; 0.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.96-4.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePLR on POD3\u003c/p\u003e\n \u003cp\u003e\u0026gt;300\u003c/p\u003e\n \u003cp\u003e\u0026lt;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2.61\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.33-5.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.61-4.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePSC: postoperative severe complications\u003c/p\u003e\n\u003cp\u003eOR: odds ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e95%CI: 95% confidence interval\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e\n\u003cp\u003eASA: American Society of Anesthesiologists physical status classification\u003c/p\u003e\n\u003cp\u003ePNI: Prognostic nutritional index=10\u0026times;albumin(g/dl) + 0.005\u0026times; the absolute lymphocyte count\u003c/p\u003e\n\u003cp\u003eCONUT: Controlling Nutritional Status\u003c/p\u003e\n\u003cp\u003ePD: Pancreaticoduodenectomy\u003c/p\u003e\n\u003cp\u003eMP: Middle pancreatectomy\u003c/p\u003e\n\u003cp\u003eTP: Total pancreatectomy\u003c/p\u003e\n\u003cp\u003eLP: left pancreatectomy with lymph node dissection\u003c/p\u003e\n\u003cp\u003eCAR: C-reactive protein to albumin ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"\"\u003eNLR: Neutrophil to lymphocyte ratio\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"\"\u003ePLR: Platelet to lymphocyte ratio\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003ePOD: Postoperative day\u003c/p\u003e\n\u003cp\u003e*: p\u0026lt; 0.05 **: p\u0026lt; 0.01 ***: p\u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Uni- and multivariate analysis to predict PSC following major liver surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"20\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e\u0026gt;75\u003c/p\u003e\n \u003cp\u003e\u0026lt;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.47-2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.39-2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026gt;22\u003c/p\u003e\n \u003cp\u003e\u0026lt;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.28-1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.28-2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.36-2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePast abdominal surgery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.58-2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative-chemotherapy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.22-1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePNI\u003c/p\u003e\n \u003cp\u003e\u0026gt;45\u003c/p\u003e\n \u003cp\u003e\u0026lt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.36-1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCONUTS\u003c/p\u003e\n \u003cp\u003eAbnormal (≧2)\u003c/p\u003e\n \u003cp\u003eNormal (\u0026lt; 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2.42\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.03-5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e3.40\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.37-8.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt; 0.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative CAR\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.03\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.64-3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative NLR\u003c/p\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.15-3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePreoperative PLR\u003c/p\u003e\n \u003cp\u003e\u0026gt;300\u003c/p\u003e\n \u003cp\u003e\u0026lt;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.04-27.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003cp\u003e2+\u003c/p\u003e\n \u003cp\u003e0/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.24-1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHistory of malignancy\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.42-1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHeart-related comorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.05-12.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.93-15.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eRespiratory-related\u003c/p\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.44-3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eLiver-related\u003c/p\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.60-3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCerebrovascular-related\u003c/p\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e6.13\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.00-118.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.05\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.53-84.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.54-2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eChronic renal dysfunction\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.50-3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003cp\u003eTri/Hemi\u003c/p\u003e\n \u003cp\u003eSec/Seg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.54-2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eMultiple organ resection\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.35-2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eOperative time (min)\u003c/p\u003e\n \u003cp\u003e\u0026gt;540\u003c/p\u003e\n \u003cp\u003e\u0026lt;540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.56-8.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eBlood loss (ml)\u003c/p\u003e\n \u003cp\u003e\u0026gt;1000\u003c/p\u003e\n \u003cp\u003e\u0026lt;1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.65-3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eBlood transfusion\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.65-3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eDate of complication diagnosis (POD)\u003c/p\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.49\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.63-3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eArterial lactic acid level on POD1 (mg/dl)\u003c/p\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.50-3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eWhite blood cell on POD3 (\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u0026micro;l)\u003c/p\u003e\n \u003cp\u003e\u0026gt;10000\u003c/p\u003e\n \u003cp\u003e\u0026lt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.23-1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCAR on POD3\u003c/p\u003e\n \u003cp\u003e\u0026gt;5.0\u003c/p\u003e\n \u003cp\u003e\u0026lt;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.29-1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eNLR on POD3\u003c/p\u003e\n \u003cp\u003e\u0026gt;10\u003c/p\u003e\n \u003cp\u003e\u0026lt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.66-4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePLR on POD3\u003c/p\u003e\n \u003cp\u003e\u0026gt;300\u003c/p\u003e\n \u003cp\u003e\u0026lt;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.17-3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSC: severe complications\u003c/p\u003e\n\u003cp\u003eOR: odds ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e95%CI: 95% confidence interval\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e\n\u003cp\u003eASA: American Society of Anesthesiologists physical status classification\u003c/p\u003e\n\u003cp\u003ePNI: Prognostic nutritional index=10\u0026times;albumin(g/dl) + 0.005\u0026times; the absolute lymphocyte count\u003c/p\u003e\n\u003cp\u003eCONUTS: Controlling Nutritional Status Score\u003c/p\u003e\n\u003cp\u003eTri: Trisegmentectomy\u003c/p\u003e\n\u003cp\u003eHemi: Hemihepatectomy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSec: Sectionectomy\u003c/p\u003e\n\u003cp\u003eSeg: Segmentectomy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCAR: C-reactive protein to albumin ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"\"\u003eNLR: Neutrophil to lymphocyte ratio\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"\"\u003ePLR: Platelet to lymphocyte ratio\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003ePOD: Postoperative day\u003c/p\u003e\n\u003cp\u003e*: p\u0026lt; 0.05 **: p\u0026lt; 0.01 ***: p\u0026lt; 0.001\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"postoperative severe complication, major liver and pancreatic surgery, inflammatory marker, controlling nutritional status","lastPublishedDoi":"10.21203/rs.3.rs-7493031/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7493031/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePostoperative severe complications (PSC) serve as critical metrics of surgical performance, significantly escalating healthcare expenditure, impeding timely initiation of adjuvant chemotherapy, and compromising long-term survival. Generally speaking, hepato-bilially-pancreatic surgeons are required to have the ability to perform and manage both liver and pancreatic surgery, which are different in nature. Therefore, it is important to have a comprehensive understanding of both liver and pancreatic surgery.This investigation aims to identify perioperative predictive factors for PSC after these surgeries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis single-center retrospective study enrolled 675 patients who underwent major liver and pancreatic surgeries between January 2010 and December 2023 at Gifu University Hospital, Japan. Perioperative predictive factors were evaluated in 328 patients with both PSC (n\u0026thinsp;=\u0026thinsp;167; liver n\u0026thinsp;=\u0026thinsp;49, pancreas n\u0026thinsp;=\u0026thinsp;118; Clavien\u0026ndash;Dindo (CD) classification grades\u0026thinsp;\u0026ge;\u0026thinsp;III) and non-PSC (n\u0026thinsp;=\u0026thinsp;161; liver n\u0026thinsp;=\u0026thinsp;53, pancreas n\u0026thinsp;=\u0026thinsp;108; CD classification grades\u0026thinsp;\u0026lt;\u0026thinsp;III) using univariate and multivariate analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePSC after major pancreatic surgery was significantly associated with male sex (p\u0026thinsp;=\u0026thinsp;0.01), higher BMI (p\u0026thinsp;=\u0026thinsp;0.03), history of smoking (p\u0026thinsp;=\u0026thinsp;0.02), history of malignancy (p\u0026thinsp;=\u0026thinsp;0.02), respiratory-related comorbidity (p\u0026thinsp;=\u0026thinsp;0.04), and CAR, NLR, and PLR on POD3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively) in the univariate analysis. In the multivariate analysis, only CAR on POD3 (\u0026gt;\u0026thinsp;5.0, OR, 4.27; 95% CI, 2.05\u0026ndash;9.13; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was an independent predictive factor for PSC after major pancreatic surgery. On the other hands, PSC after major liver surgery was significantly associated with an abnormal CONUT score (p\u0026thinsp;=\u0026thinsp;0.04) and heart-related comorbidities (p\u0026thinsp;=\u0026thinsp;0.04) in the univariate analysis. In the multivariate analysis, only an abnormal CONUT score (OR, 3.40; 95% CI, 1.37\u0026ndash;8.81; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) was an independent predictive factor for PSC following major liver surgery .\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePostoperative inflammatory markers may be early predictive factors for complication severity after major pancreatectomy. On the other hand, an abnormal preoperative CONUT score was an independent predictor of major liver surgery. The study advocates for the implementation of proactive postoperative strategies guided by inflammatory biomarkers in major pancreatic surgery and posits that targeted nutritional optimization prior to major hepatectomy may facilitate expedited recovery and favorable outcomes.\u003c/p\u003e","manuscriptTitle":"Early predictive factors for severe postoperative complications following major liver and pancreatic surgery: A single-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:10:33","doi":"10.21203/rs.3.rs-7493031/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93556b5b-70ec-4669-b508-1b2ce5085b90","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-04T13:39:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:10:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7493031","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7493031","identity":"rs-7493031","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}