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, Bathiya Lee, Shiela French, Jeremy J Wilson, Colin Roberts, Keith J Loveday, Benjamin P T Manas, Derek Windsor, John White, Steve
Chong, Eric
Ratnayake, Bathiya
Lee, Shiela
French, Jeremy J
Wilson, Colin
Roberts, Keith J
Loveday, Benjamin P T
Manas, Derek
Windsor, John
White, Steve
Abstract
Background: Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016 International Study Group of Pancreatic Fistula (ISGPF) definition.
Methods: A systemic search of MEDLINE, Pubmed, Scopus, and EMBASE were conducted using the PRISMA framework. Studies were evaluated for risk factors for the development CR-POPF after DP using the 2016 ISGPF definition. Further subgroup analysis was undertaken on studies ≥10 patients in exposed and non-exposed subgroups.
Results: Forty-three studies with 8864 patients were included in the meta-analysis. The weighted rate of CR-POPF was 20.4% (95%-CI: 17.7-23.4%). Smoking (OR 1.29, 95%-CI: 1.08-1.53, p = 0.02) and open DP (OR 1.43, 95%-CI: 1.02-2.01, p = 0.04) were found to be significant risk factors of CR-POPF. Diabetes (OR 0.81, 95%-CI: 0.68-0.95, p = 0.02) was a significant protective factor against CR-POPF. Substantial heterogeneity was observed in the comparisons of pancreatic texture and body mass index. Seventeen risk factors achieved significance in a univariate or multivariate comparison as reported by individual studies in the narrative synthesis, however, they remain difficult to interpret as statistically significant comparisons were not uniform.
Conclusion: This meta-analysis found smoking and open DP to be risk factors and diabetes to be protective factor of CR-POPF in the era of 2016 ISGPF definition.
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Date
2021-03-18
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Chong E, Ratnayake B, Lee S, French JJ, Wilson C, Roberts KJ, Loveday BPT, Manas D, Windsor J, White S, Pandanaboyana S. 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. HPB (Oxford). 2021 Aug;23(8):1139-1151. doi: 10.1016/j.hpb.2021.02.015. Epub 2021 Mar 18