Impact of postoperative pancreatic fistula on long-term oncologic outcomes after pancreatic resection

Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

“…The MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library searches yielded a total of 4045 citations ( Figure 1 ), and a consensus among all investigators led to 16 studies being judged as eligible for our meta-analysis [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Screening the references of the full-text articles assessed for eligibility revealed no further studies potentially suitable for inclusion.…”

“…Screening the references of the full-text articles assessed for eligibility revealed no further studies potentially suitable for inclusion. Eleven studies reporting DFS data (n = 3375 patients) [ 15 , 17 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 ] and sixteen studies containing information about OS (n = 5019 patients) were included in the meta-analysis [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] ( Figure 1 ). Correlation between long-term survival and POPF was assessed as the primary endpoint in 14 studied [ 14 , 15 , 16 , 17 , 18 , 19 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]; only two studies considered all complications [ 21 ] and the analysis of prognostic factors [ 20 ] as primary endpoints, and POPF impact as a secondary endpoint.…”

“…Of the 16 retrospective cohort studies analyzed [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], 2 [ 19 , 29 ] were multicentric, and concerned a total of 5019 patients with an overall POPF rate of 20.78% (n = 1043 patients) and a CR-POPF rate of 12.63% (n = 634 patients). Table 1 and Supplementary Table S2 show the main characteristics of these studies.…”

“…Eleven studies [ 15 , 17 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 ] provided DFS data for patients with POPF or CR-POPF, as shown in Table 2 and Supplementary Table S3 . The median DFS rates of whole cohorts, reported in only three studies [ 17 , 21 , 29 ], ranged from 12.2 [ 17 ] to 19 months [ 29 ].…”

“…Four studies described the impact of POPF (grades A–C) on DFS [ 17 , 22 , 23 , 25 ]: DFS was significantly shorter in the POPF group in the study by Dundar et al [ 22 ], while no significant difference was seen in the other three studies [ 17 , 23 , 25 ]. Six studies reported the impact of CR-POPF (grades B and C) on DFS [ 15 , 21 , 25 , 27 , 28 , 29 ], with only Watanabe et al and Nagai et al reporting a significantly shorter DFS in their CR-POPF groups [ 15 , 21 , 28 ]. The one study that considered subgroups of patients with grade-C POPF [ 19 ] found no significant differences in DFS via multivariate analysis.…”