Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

Chong, Eric; Ratnayake, Chathura B B; Lee, Shiela; French, Jeremy; Wilson, Colin; Roberts, Keith; Loveday, Benjamin; Manas, Derek; Windsor, John A.; White, Steve; Pandanaboyana, Sanjay

doi:10.1016/j.hpb.2021.02.015

Cited by 55 publications

(61 citation statements)

References 85 publications

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“…In their study, rates of complications and severe complications were 62.5% (175/280) and 39.6% (111/280), respectively. Also, POPF occurred in 23.6% of cases—18.6% being grade B and 5% being grade C. In a recent meta-analysis, a total of 8,864 patients who underwent DP were included, and POPF occurred in 20.4%, with 20.2% and 1.6% being grades B and C, respectively ( 20 ). In our study, rates of complications and severe complications in the DP group were 57.6% and 18.2%, respectively, which were higher than those of 43.4% and 13.2% in the non-DP group, respectively, but not significantly so.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant

Kim

Lee

et al. 2021

Front. Oncol.

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BackgroundEn bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). However, resection of the pancreas is controversial because it may cause serious complications, such as pancreatic fistula or bleeding. Thus, we evaluated the outcomes of distal pancreatectomy (DP) in pancreas-abutting RPS of the left upper quadrant (LUQ).MethodsWe retrospectively reviewed all consecutive patients who underwent surgery for RPS between September 2001 and April 2020. We selected 150 patients with all or part of their tumor located in the LUQ on preoperative computed tomography. Eighty-six patients who had tumors abutting the pancreas were finally enrolled in our study.ResultsFifty-three patients (53/86; 61.6%) were included in the non-DP group, and 33 patients (33/86; 38.4%) were included in the DP group. Total postoperative complications and complication rates for those Clavien–Dindo grade 3 or higher were similar between the non-DP group and DP group (p = 0.290 and p = 0.550). In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients. During multivariate analysis, microscopic pancreatic invasion was deemed a risk factor for local recurrence (p = 0.029). However, there were no significant differences on preoperative computed tomography findings between the pancreatic invasion and non-invasion groups.ConclusionDP is a reasonable procedure for pancreas-abutting RPS located at the LUQ when both complications and complete resection are considered.

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Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant

Kim

Lee

et al. 2021

Front. Oncol.

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“…The prognosis for pancreatic cancer is generally poor, with five-year survival rates in the range of 6% to 10% [ 16 , 17 ]. Radical surgical resection represents the only potential cure.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

Pierobon

Moletta

Zampieri

et al. 2021

JCM

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Low muscle mass is associated with reduced survival in patients with different cancer types. The interest in preoperative sarcopenia and pancreatic cancer has risen in the last decade as muscle mass loss seems to be associated with poorer survival, higher postoperative morbidity, and mortality. The aim of the present study was to review the literature to compare the impact of low muscle mass on the outcomes of patients undergoing surgery for pancreatic adenocarcinoma. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 10 articles were analyzed in detail and included in the meta-analysis. Data were retrieved on 2811 patients undergoing surgery for pancreatic cancer. Meta-analysis identified that patients with low muscle mass demonstrated a significantly reduced OS when compared to patients without alterations of the muscle mass (ROM 0.86; 95% CI: 0.81–0.91, p < 0.001), resulting in a 14% loss for the former. Meta-analysis failed to identify an increase in the postoperative complications and length of stay of patients with low muscle mass. Our analysis confirms the role of low muscle mass in influencing oncologic outcomes in pancreatic cancer. Its role on surgical outcomes remains to be established.

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“…The present study also indicated absence of DM as an independent risk factor in multivariate analysis. Although few report have indicatedabsence of DM as a risk factor, a recent meta-analysis [15] reported that DM was a signi cant protective factor for CR-POPF after DP. Exocrine function as well as endocrine function was reduced in DM patients [18], therefore this may have increased the incidence of POPF.…”

Section: Discussionmentioning

confidence: 98%

“…The incidence of POPF after DP differs between reports, but the results of a large-scale, multi-center, joint study in Japan in 2015 [11] reported an incidence of 28.2% with open surgery and 18.4% withlaparoscopic surgery. Several DP-related randomized controlled trials after 2016 [12][13][14]reported POPF incidence rates of 16.0%-18.9%, and a recent meta-analysis [15] reported an incidence of 20.4%, indicating thatthis complication hasa relatively high frequency of occurrence regardless of advancementsin surgical techniques. The incidence of CR-POPF in the present study was 34.3%, higherthan that in previous reports.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Analysis of Postoperative Pancreatic Fistula After Distal Pancreatectomy, with A Focus on Pancreas-Visceral Fat CT Value Ratio and Serrated Pancreatic Contour, Evaluated Using Preoperative CT Images: A Retrospective Single Center Study

Maeda

Kuriyama

Yuge

et al. 2022

Preprint

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Background: In pancreaticoduodenectomy, the pancreas-visceral fat CT value ratio and serrated pancreatic contour on preoperative CT have been revealed as risk factors for postoperative pancreatic fistulas. We aimed to evaluate whether they could also serve as risk factors for postoperative pancreatic fistulas after distal pancreatectomy. Methods: A total of 251 patients that underwent distal pancreatectomy at our department from 2006 to 2020 were enrolled for the study. We retrospectively analyzed risk factors for postoperative pancreatic fistulas after distal pancreatectomy using various pre and intraoperative factors, including preoperative CT findings, such as pancreas-visceral fat CT value ratio and serrated pancreatic contour. Results: The study population included 147 male and 104 female participants (median age, 68 years; median body mass index, 21.4 kg/m2), including 64 patients with diabetes mellitus (25.5%). Preoperative CT evaluation showed a serrated pancreatic contour in 80 patients (31.9%), a pancreatic thickness of 9.3 mm (4.0–22.0 mm), pancreatic parenchymal CT value of 41.8 HU (4.3–22.0 HU), and pancreas-visceral fat CT value ratio of -0.41 (-4.88 to -0.04). Postoperative pancreatic fistulas were developed in 34.2% of the patients. Univariate analysis of risk factors for postoperative pancreatic fistulas showed that younger age (P = 0.005), high body mass index (P = 0.001), absence of diabetes mellitus (P = 0.002), high preoperative C-reactive protein level (P = 0.024), pancreatic thickness (P < 0.001), and high pancreatic parenchymal CT value (P = 0.018) were significant risk factors; however, pancreas-visceral fat CT value ratio (P = 0.337) and a serrated pancreatic contour (P = 0.122) did not serve as risk factors. Multivariate analysis showed that high body mass index (P = 0.032), absence of diabetes mellitus (P = 0.001), and pancreatic thickness (P < 0.001) were independent risk factors. Conclusion: The pancreas-visceral fat CT value ratio and serrated pancreatic contour evaluated using preoperative CT were not risk factors for postoperative pancreatic fistulas after distal pancreatectomy. High body mass index, absence of diabetes mellitus, and pancreatic thickness were independent risk factors, and a close-to-normal pancreas with minimal fat deposition or atrophy is thought to indicate a higher risk of postoperative pancreatic fistulas after distal pancreatectomy.

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Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

Cited by 55 publications

References 85 publications

Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant

Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant

The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

Risk Factor Analysis of Postoperative Pancreatic Fistula After Distal Pancreatectomy, with A Focus on Pancreas-Visceral Fat CT Value Ratio and Serrated Pancreatic Contour, Evaluated Using Preoperative CT Images: A Retrospective Single Center Study

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