Overall Postoperative Morbidity and Pancreatic Fistula Are Relatively Higher after Central Pancreatectomy than Distal Pancreatic Resection: A Systematic Review and Meta-Analysis

Abstract

Objective. To compare the intraoperative and postoperative outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). Methods. A systematic literature search was performed on electronic databases from MEDLINE, Embase, and PubMed from 1998 to 2018. Statistical analysis and meta-analysis were performed using statistics/data analysis (Stata®) software, version 12.0 (StataCorp LP, College Station, Texas 77845, USA). Dichotomous variables were analyzed by estimation of relative risk (RR) with a 95 percent (%) confidence interval (CI) and continuous variables were analyzed by standardized mean differences (SMD) with 95% CI. Results. Twenty-four studies with 593 CP and 1226 DP were included in the meta-analysis. CP had significantly longer operation time (SMD: 1.03; 95% CI 0.62 to 1.44; P<0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P<0.01). Estimated blood loss was significantly lower in CP (SMD: −0.34; 95% CI −0.58 to −0.09; P=0.007). Overall postoperative morbidity (RR: 1.30; 95% CI: 1.13 to 1.50; P<0.001), overall pancreatic fistula (RR: 1.41; 95% CI: 1.20 to 1.66; P<0.001), clinically relevant fistula (RR: 1.64; 95% CI: 1.25 to 2.16; P<0.001), and postoperative hemorrhage (RR: 1.90; 95% CI: 1.18 to 3.06; P<0.05) were all significantly higher after CP. On long-term follow-up, DP patients were more likely to have postoperative exocrine (RR: 0.56; 95% CI: 0.37 to 0.84; P<0.05) and endocrine (RR: 0.27; 95% CI: 0.18 to 0.40; P<0.001) insufficiency. There was no statistically significant difference in transfusion requirement, postoperative mortality, reoperation, and tumor recurrence. Conclusion. CP is associated with significantly higher morbidity and clinically relevant pancreatic fistula. CP should only be reserved for selected patients who require postoperative pancreatic function preservation.

Nomogram predicts CR-POPF in open central pancreatectomy patients with benign or low-grade malignant pancreatic neoplasms

“…Besides, patients for whom CP is advised usually have benign or low-grade pancreatic malignancies with soft texture and a small MPD in the vast majority of cases, all of these have been demonstrated to be significant risk factors for POPF (12)(13)(14). These risk factors are independent of the surgeon's intervention and the incidence of POPF after CP has been reported to exceed that after standard PD or DP (5)(6)(7)(8)(9)(10). POPF remains a severe and challenging complication of CP and is a key contributor to most of the postoperative complications, such as post-pancreatectomy hemorrhage and abdominal abscess, promoting operationrelated morbidity, mortality and prolonged hospitalization (5)(6)(7)(8)(9)(10).…”

“…These risk factors are independent of the surgeon's intervention and the incidence of POPF after CP has been reported to exceed that after standard PD or DP (5)(6)(7)(8)(9)(10). POPF remains a severe and challenging complication of CP and is a key contributor to most of the postoperative complications, such as post-pancreatectomy hemorrhage and abdominal abscess, promoting operationrelated morbidity, mortality and prolonged hospitalization (5)(6)(7)(8)(9)(10). Indeed, POPF is the "Achilles heel" of CP (11).…”

“…However, CP leaves two divided pancreatic remnants, creating more opportunities for postoperative pancreatic fistula (POPF) formation. There have been many reports of higher POPF incidence following CP than after PD or DP (5)(6)(7)(8)(9)(10). POPF is a severe and challenging complication of CP, contributing to postoperative morbidity, due to post-pancreatectomy hemorrhage, surgical site infection or abdominal abscess, mortality and prolonged hospitalization (5)(6)(7)(8)(9)(10).…”

“…There have been many reports of higher POPF incidence following CP than after PD or DP (5)(6)(7)(8)(9)(10). POPF is a severe and challenging complication of CP, contributing to postoperative morbidity, due to post-pancreatectomy hemorrhage, surgical site infection or abdominal abscess, mortality and prolonged hospitalization (5)(6)(7)(8)(9)(10). It has been described as the "Achilles heel" of CP (11).…”

Is central pancreatectomy an effective alternative to distal pancreatectomy for low-grade pancreatic neck and body tumors: A 20-year single-center propensity score-matched case-control study

“…However, the rate of clinically relevant POPF was similar between the groups. However, a meta-analysis by Regmi et al [ 18 ] (relative risk 1.64, p < 0.001) and Dragomir et al [ 19 ] (odds ratio 2.24, p < 0.0001) showed a significantly higher incidence of clinically relevant fistulas after CP [ 17 ]. This observed difference might be due to our institutional practice of trans-jejunal external stenting of PD.…”