Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

Abstract

Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). However, the risk factors of this complication in patients after DP still remain controversial. The aim of our study is to estimate the association between potential risk factors and POPF. Relevant articles published up to June 21, 2016 were identified via PubMed, EMBASE, Web of Science, and The Cochrane Library. Studies that examined the risk factors of POPF following DP were enrolled. 20 articles (2070 patients) were finally included in this study. The pooled data suggested that patients with soft pancreas, higher Body Mass Index (BMI), blood transfusion, elevated intraoperative blood loss, and longer operative time had a decreased risk for POPF. However, age, gender, malignant pathology, types of stump closure, octreotide therapy, history of diabetes and chronic pancreatitis, splenectomy, multiorgan resection, main duct ligation, preoperative serum albumin levels, PGA felt wrapping, and extended lymphadenectomy could not be regarded as risk factors for POPF. Our analytic data demonstrated that pancreas texture, BMI, blood transfusion, intraoperative blood loss, and operative time were clinical predictor for POPF. This study may assist surgeons to screen patients with high risk of POPF and select appropriate treatment measures.

Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

“…For our group of patients, statistical data showed that age is not a risk factor (with an average age of 59.93 years for those without fistula and 53.29 for those with fistula, p = 0.173) Also in a meta-analysis performed on 10 large patient trials, only one study found an increase incidence of pancreatic fistula in older patients [7]. Table 3 Table 2 Table 4 The relative risk for patients receiving Sandostatin is RR = 2.03, which means that these patients have a twofold risk of developing pancreatic fistula.…”

“…An explanation of an incidence of only 15.59% of the pancreatic fistula may be due to the fact that our study group was performed only on patients with malignant pathology. There are studies concluding that malignant tumors are associated with a low risk of fistula [7,8].…”

“…Reducing the occurrence of postoperative pancreatic fistula still remains a challenge for surgeons, so it is essential to identify risk and protection factors. Factors that seem to influence the incidence of pancreatic fistula are: obesity, age, diabetes history, intraoperative blood loss and operative time, preoperative serum albumin levels, preoperative blood tranfusion and the factors related to pancreas texture, such as soft pancreas, a small Wirsung duct size, types of stump closure and extended limphadenectomy [7][8][9][10]. The role of sandostatin in reducing the occurrence of postoperative pancreatic fistula remains uncertain.…”

A Novel Way of Preventing Postoperative Pancreatic Fistula by Directly Injecting Profibrogenic Materials into the Pancreatic Parenchyma

“…Procedure-related factors include anastomotic technique, operation time, and intraoperative blood loss. Of them, numerous studies consistently indicated that pancreatic texture is the most contributory predictor of POPF [28,[30][31][32]. Several meta-analyses reported that patients with soft pancreas have the significantly higher incidence of POPF than did those with hard pancreas [32,33].…”

“…Of them, numerous studies consistently indicated that pancreatic texture is the most contributory predictor of POPF [28,[30][31][32]. Several meta-analyses reported that patients with soft pancreas have the significantly higher incidence of POPF than did those with hard pancreas [32,33]. Soft pancreas has poor suture holding capacity (SHC) and is frequently associated with parenchymal tearing arising from technical difficulties [31,34].…”