Comprehensive Analysis of the Effect of Ketorolac Administration after Pancreaticoduodenectomy

Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

“…Therefore, the effect of surgeons’ experience on the primary outcome in this study would have been small. Fourth, the median value of the ketorolac dose in this study was 30 mg, which was relatively small compared to that in previous studies [ 11 - 13 ]. Therefore, we could not identify the dose-dependent effect of ketorolac on the development of POPF.…”

“…In addition, the study had a small sample size, and there was no information about pancreatic gland texture and duct size in approximately 30% of the patients. The most recent study reported no association between postoperative ketorolac use and CR-POPF [11].…”

“…In addition, the study had a small sample size, and there was no information about pancreatic gland texture and duct size in approximately 30% of the patients. The most recent study reported no association between postoperative ketorolac use and CR-POPF [ 11 ]. However, it was still difficult to conclude the safety of using ketorolac for PD due to their wide CI, including substantial adverse effects (any ketorolac, OR: 1.99, 95% CI [0.93, 4.26], P = 0.08), but the authors supported the safety of using ketorolac for PD, noting that the incidence of CR-POPF remained stable despite the great increase in the use of ketorolac at their institution.…”

“…However, the detrimental effect of NSAIDs on AL following a PD has rarely been reported [11][12][13]. Therefore, investigating the association between NSAID use and the risk of AL, including postoperative pancreatic fistula (POPF), which is the most challenging complication following a PD, is important.…”

Non-Surgical Interventions for the Prevention of Clinically Relevant Postoperative Pancreatic Fistula—A Narrative Review

“…The study exploring postoperative NSAIDs with the highest number of PD patients found that NSAIDs were associated with significantly greater CR-POPF [80]. In smaller studies considering non-selective NSAIDs, no difference in CR-POPF was reported after PD [81][82][83][84], even in high-risk (>40% acinar cell density) patients [76]. However, in some of these analyses, important confounders such as pancreas texture and duct size were not controlled for, potentially underestimating the harmful effects of NSAIDs through the inclusion of lower-risk patients [81,84].…”