Supplementary Material for: The Impact of Stump Closure Techniques on Pancreatic Fistula Stratified by the Thickness of the Pancreas in Distal Pancreatectomy

<b><i>Background:</i></b> The purpose of this retrospective study was to evaluate the impact of stump closure techniques on pancreatic fistula (PF) focusing on pancreatic thickness after distal pancreatectomy (DP). <b><i>Methods:</i></b> A total of 213 patients who underwent DP between 2007 and 2017 were retrospectively reviewed. The risk factors of PF were investigated. <b><i>Results:</i></b> In all patients, age ≥65 years (odds ratio [OR]: 3.60, <i>p</i> = 0.012), operation time ≥300 min (OR: 3.05, <i>p</i> = 0.013) and thickness of transected pancreas (OR: 1.37, <i>p</i> &lt; 0.001) were identified as independent risk factors for clinically relevant PF. A receiver operating curve analysis revealed the optimum cut-off values of thickness to be 14 mm with stapler closure and 17 mm with the clamp-crushing method. There were no significant differences regarding PF between the stapler closure and clamp-crushing methods in the thin (&lt;14 mm) and very thick pancreas (≥17 mm) groups (<i>p</i> = 0.822, <i>p</i> = 0.072). In contrast, stapler closure was the only independent risk factor for developing PF in the moderately thick (≥14, &lt;17 mm) pancreas group (OR: 6.75 and <i>p</i> = 0.004, respectively). <b><i>Conclusion:</i></b> The clamp-crushing method was superior to stapler closure for pancreatic transection, especially in patients with moderately thick pancreas.