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Meta-Analysis
. 2022 Jul 1;101(26):e29757.
doi: 10.1097/MD.0000000000029757.

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Biao Zhang  1   2 , Qihang Yuan  1   2 , Shuang Li  1   2 , Zhaohui Xu  3 , Xu Chen  1   2 , Lunxu Li  1   2 , Dong Shang  1   2
Affiliations
Meta-Analysis

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Biao Zhang et al. Medicine (Baltimore). .

Abstract

Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD.

Methods: We searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test.

Results: A total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%-19%). Male (OR = 1.56, 95% CI: 1.42-1.70), body mass index >25 kg/m2 (OR = 1.98, 95% CI: 1.23-3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66-2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61-4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01-4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47-0.61), vascular resection (OR = 0.57, 95% CI: 0.39-0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57-0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40-1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis.

Conclusions: The current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow diagram of study inclusion and exclusion.
Figure 2.
Figure 2.
The pooled incidence of CR-POPF after PD. CR-POPF = clinically relevant postoperative pancreatic fistula, PD = pancreatoduodenectomy.
Figure 3.
Figure 3.
Forest plot of the relationship between CR-POPF and gender. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 4.
Figure 4.
Forest plot of the relationship between CR-POPF and BMI (25 kg/m2). BMI = body mass index, CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 5.
Figure 5.
Forest plot of the relationship between CR-POPF and pancreatic duct diameter (3 mm). CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 6.
Figure 6.
Forest plot of the relationship between CR-POPF and pancreatic texture. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 7.
Figure 7.
Forest plot of the relationship between CR-POPF and pathology type. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 8.
Figure 8.
Forest plot of the relationship between CR-POPF and diabetes mellitus. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 9.
Figure 9.
Forest plot of the relationship between CR-POPF and blood transfusion. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 10.
Figure 10.
Forest plot of the relationship between CR-POPF and vascular resection. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 11.
Figure 11.
Forest plot of the relationship between CR-POPF and preoperative chemoradiotherapy. CR-POPF = clinically relevant postoperative pancreatic fistula.
Figure 12.
Figure 12.
Funnel plot showed no significant publication bias in the analysis of gender.
Figure 13.
Figure 13.
Funnel plot showed no significant publication bias in the analysis of pancreatic texture.
Figure 14.
Figure 14.
Funnel plot showed no significant publication bias in the analysis of pathology type.
See this image and copyright information in PMC

References

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