Neck transection level and postoperative pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study of 195 patients

Bardol, Thomas; Delicque, Julien; Hermida, Margaux; Herrero, Astrid; Guiu, Boris; Fabre, Jean‐Michel; Souche, Regis

doi:10.1016/j.ijsu.2020.08.001

Cited by 15 publications

(14 citation statements)

References 39 publications

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“…Seven studies [ 16 , 27 , 29 , 32 , 33 , 38 , 39 ] analyzed the relationship of pancreatic duct diameter <3 mm and CR-POPF, involving 12,325 patients. The fixed effects model was used for data synthesis because of a low heterogeneity ( I 2 = 28%) among the 7 studies.…”

Section: Resultsmentioning

confidence: 99%

“…The association of vascular resection and CR-POPF was assessed by 6 studies with 5462 patients. [ 20 , 21 , 28 , 32 , 33 , 36 ] There was no heterogeneity ( I 2 = 0%), so the fixed-effects model was adopted. The result showed that intraoperative vascular resection was a significant protective factor of CR-POPF (OR = 0.57, 95% CI: 0.39–0.83, P = .003) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The relationship of pathology type and CR-POPF was assessed by 10 studies with 14,487 patients. [13,21,27,28,[32][33][34][35]38,39] There was a low heterogeneity (I 2 = 33%), and the fixed effects model was used. The pooled data indicated that compared with other pathology types, pancreatic adenocarcinoma was a significant protective factor of CR-POPF (OR = 0.54, 95% CI: 0.47-0.61, P < .001) (Fig.…”

Section: Pathology Typementioning

confidence: 99%

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Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang

Yuan

et al. 2022

Medicine

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Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD. Methods: We searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test. Results: A total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%–19%). Male (OR = 1.56, 95% CI: 1.42–1.70), body mass index >25 kg/m 2 (OR = 1.98, 95% CI: 1.23–3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66–2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61–4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01–4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47–0.61), vascular resection (OR = 0.57, 95% CI: 0.39–0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57–0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40–1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis. Conclusions: The current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Pathology Typementioning

confidence: 99%

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Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang

Yuan

et al. 2022

Medicine

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“…A total of 37 studies 10,11,[28][29][30]33,34,37,39,44,45,[48][49][50][51][52][53]55,[58][59][60][61][62][63][64]72,74,75,77,81,83,87,87,[123][124][125] with 14,471 patients investigated MPD diameter as a risk factor for CR-POPF, applying different cut-offs. Irrespective of the cut-off, duct diameter was associated with CR-POPF (OR 3.14, 95% CI 2.53-3.90, P < 0.01) (Fig.…”

Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

“…Again, results were comparable when including only the 49 studies that assessed the MPD intraoperatively (OR 3.21, 95% CI 2.70-3.81, P < 0.01) The studies included for analysis used different cutoff values for MPD diameter. Twelve studies 10,44,55,59,63,72,75,77,81,83,123,124 including 4660 patients classified MPD diameter of r 3mm as a high risk for CR-POPF development (OR 2.99, 95% CI 2.17-4.13, P < 0.01). Another 20 studies 11,29,30,33,37,39,44,45,[48][49][50][51]58,61,62,64,74,79,87,125 with 9067 patients used MPD diameter of ≤3 mm as the high-risk cut-off, although the results were comparable (OR 3.66, 95% CI 2.62-5.12, P < 0.01).…”

Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

et al. 2021

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Objective: The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD). Summary Background Data: Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking. Methods: A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort. Results: Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62–5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively (P < 0.001). Conclusion: For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results.

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Prevention and Treatment of Pancreatic Fistulae and Leaks in Carcinoma Pancreas

Jamir,

Kumar,

Sood

et al. 2024

Complications of Cancer Therapy: Best Practices in Prevention and Management

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Neck transection level and postoperative pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study of 195 patients

Cited by 15 publications

References 39 publications

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

Prevention and Treatment of Pancreatic Fistulae and Leaks in Carcinoma Pancreas

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