Systematic review and meta-analysis of risk factors of POPF after distal pancreatectomy in the era of 2016 international study group pancreatic fistula definition

Chong, Eric; Ratnayake, B.; Lee, S.; French, J.; Wilson, C. Ellie; Roberts, Keith; Loveday, Benjamin; Windsor, J. A.; White, S.; Pandanaboyana, Sanjay

doi:10.1016/j.hpb.2021.08.358

HPB

2021

DOI: 10.1016/j.hpb.2021.08.358

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Systematic review and meta-analysis of risk factors of POPF after distal pancreatectomy in the era of 2016 international study group pancreatic fistula definition

Eric Chong

B. Ratnayake

S. Lee

et al.

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2024

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Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy

Lee

Yoon²,

Han³

et al. 2023

World j. surg.

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Background The current definition for postoperative pancreatic fistula (POPF) is based on the drain fluid amylase (DFA), and drains must be positioned adequately. We investigated the impact of DFA level, drain position and fluid collection after distal pancreatectomy (DP). Methods We performed a retrospective study of 516 patients who underwent DP between June 2004 and December 2018. Patients were excluded if DP was not main procedure, DFA was not measured, postoperative computed tomography (CT) was not performed, or drains were removed before CT. Demographic and perioperative data were analyzed in 422 eligible patients. Results Of 422 patients, 49(11.6%) had clinically relevant (CR)-POPF and 102(24.2%) had a malpositioned drain. There was no difference in CR-POPF rate between the high and low DFA groups (12.6% vs 10.7%, P = 0.649). Drain malposition was more frequently associated with symptomatic fluid collection and CR-POPF than wellpositioned drains. Male sex, high body mass index, transfusion, and drain malposition were CR-POPF risk factors. In subgroup analysis, drain malposition was also an independent risk factor for CR-POPF in the low DFA group. Conclusions After DP, the incidence of CR-POPF in the high and low DFA groups was similar and drain malposition increased the risk of CR-POPF. Thus, the ISGPS definition of POPF based on DFA levels is limited in DP, and DFA levels should be interpreted together with the drain position.

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Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy

Lee

Yoon²,

Han³

et al. 2023

World j. surg.

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Prolonged pre-firing pancreatic compression with linear staplers in distal pancreatectomy: a valuable technique for post-operative pancreatic fistula prevention

Quero,

Laterza,

Schena

et al. 2024

Langenbecks Arch Surg

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Purpose Post-operative pancreatic fistula (POPF) remains the main complication after distal pancreatectomy (DP). The aim of this study is to evaluate the potential benefit of different durations of progressive stapler closure on POPF rate and severity after DP. Methods Patients who underwent DP between 2016 and 2023 were retrospectively enrolled and divided into two groups according to the duration of the stapler closure: those who underwent a progressive compression for < 10 min and those for ≥ 10 min. Results Among 155 DPs, 83 (53.5%) patients underwent pre-firing compression for < 10 min and 72 (46.5%) for ≥ 10 min. As a whole, 101 (65.1%) developed POPF. A lower incidence rate was found in case of ≥ 10 min compression (34–47.2%) compared to < 10 min compression (67- 80.7%) (p = 0.001). When only clinically relevant (CR) POPFs were considered, a prolonged pre-firing compression led to a lower rate (15–20.8%) than the < 10 min cohort (32–38.6%; p = 0.02). At the multivariate analysis, a compression time of at least 10 min was confirmed as a protective factor for both POPF (OR: 5.47, 95% CI: 2.16–13.87; p = 0.04) and CR-POPF (OR: 2.5, 95% CI: 1.19–5.45; p = 0.04) development. In case of a thick pancreatic gland, a prolonged pancreatic compression for at least 10 min was significantly associated to a lower rate of CR-POPF compared to < 10 min (p = 0.04). Conclusion A prolonged pre-firing pancreatic compression for at least 10 min seems to significantly reduce the risk of CR-POPF development. Moreover, significant advantages are documented in case of a thick pancreatic gland.

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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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Systematic review and meta-analysis of risk factors of POPF after distal pancreatectomy in the era of 2016 international study group pancreatic fistula definition

Cited by 3 publications

References 0 publications

Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy

Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy

Prolonged pre-firing pancreatic compression with linear staplers in distal pancreatectomy: a valuable technique for post-operative pancreatic fistula prevention

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

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