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Review
. 2021 Nov 19;13(22):5803.
doi: 10.3390/cancers13225803.

Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Andrea Grego  1 , Alberto Friziero  1 , Simone Serafini  1 , Amanda Belluzzi  1 , Lucia Moletta  1 , Luca Maria Saadeh  1 , Cosimo Sperti  1
Affiliations
Review

Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Andrea Grego et al. Cancers (Basel). .

Abstract

Background: The impact of postoperative pancreatic fistula (POPF) on survival after resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear.

Methods: The MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting on survival in patients with and without POPF. A meta-analysis was performed to investigate the impact of POPF on disease-free survival (DFS) and overall survival (OS).

Results: Sixteen retrospective cohort studies concerning a total of 5019 patients with an overall clinically relevant POPF (CR-POPF) rate of 12.63% (n = 634 patients) were considered. Five of eleven studies including DFS data reported higher recurrence rates in patients with POPF, and one study showed a higher recurrence rate in the peritoneal cavity. Six of sixteen studies reported worse OS rates in patients with POPF. Sufficient data for a meta-analysis were available in 11 studies for DFS, and in 16 studies for OS. The meta-analysis identified a shorter DFS in patients with CR-POPF (HR 1.59, p = 0.0025), and a worse OS in patients with POPF, CR-POPF (HR 1.15, p = 0.0043), grade-C POPF (HR 2.21, p = 0.0007), or CR-POPF after neoadjuvant therapy.

Conclusions: CR-POPF after resection for PDAC is significantly associated with worse overall and disease-free survival.

Keywords: POPF; overall survival; pancreatectomy; pancreatic adenocarcinoma; pancreatic cancer; postoperative pancreatic fistula; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart showing the selection process of papers.
Figure 2
Figure 2
Forest plot summarizing the meta-analysis to compare disease-free survival in patients with and without postoperative pancreatic fistula (POPF) or clinically relevant postoperative pancreatic fistula (CR-POPF). HR: hazard ratio; 95% CI: 95% confidential interval.
Figure 3
Figure 3
Forest plot summarizing the meta-analysis to compare overall survival in patients with and without postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), grade-B POPF, grade-C POPF, or CR-POPF in patients who underwent neoadjuvant therapy. HR: hazard ratio; 95% CI: 95% confidential interval.
See this image and copyright information in PMC

References

    1. Figueras J., Sabater L., Planellas P., Muñoz-Forner E., Lopez-Ben S., Falgueras L., Sala-Palau C., Albiol M., Ortega-Serrano J., Castro-Gutierrez E. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br. J. Surg. 2013;100:1597–1605. doi: 10.1002/bjs.9252. - DOI - PubMed
    1. Reid-Lombardo K.M., Farnell M.B., Crippa S., Barnett M., Maupin G., Bassi C., Traverso L.W. Pancreatic Anastomotic Leakage After Pancreaticoduodenectomy in 1,507 Patients: A Report from the Pancreatic Anastomotic Leak Study Group. J. Gastrointest. Surg. 2007;11:1451–1459. doi: 10.1007/s11605-007-0270-4. - DOI - PubMed
    1. Bassi C., Dervenis C., Butturini G., Fingerhut A., Yeo C., Izbicki J., Neoptolemos J., Sarr M., Trasverso W., Buchler M. Postoperative pancreatic fistula: An international study group (ISGPF) definition. Surgery. 2005;138:8–13. doi: 10.1016/j.surg.2005.05.001. - DOI - PubMed
    1. Hackert T., Hinz U., Pausch T., Fesenbeck I., Strobel O., Schneider L., Fritz S., Büchler M.W. Postoperative pancreatic fistula: We need to redefine grades B and C. Surgery. 2016;159:872–877. doi: 10.1016/j.surg.2015.09.014. - DOI - PubMed
    1. Correa-Gallego C., Brennan M.F., D’Angelica M.I., Dematteo R.P., Fong Y., Kingham T.P., Jarnagin R., Allen P.J. Contemporary Experience with Postpancreatectomy Hemorrhage: Results of 1,122 Patients Resected between 2006 and 2011. J. Am. Coll. Surg. 2012;215:616–621. doi: 10.1016/j.jamcollsurg.2012.07.010. - DOI - PubMed

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