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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

Lookup NU author(s): Jeremy French, Dr Colin Wilson, Professor Derek Manas, Steven White, Sanjay PandanaboyanaORCiD


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© 2021 International Hepato-Pancreato-Biliary Association Inc. 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.

Publication metadata

Author(s): Chong E, Ratnayake B, Lee S, French JJ, Wilson C, Roberts KJ, Loveday BPT, Manas D, Windsor J, White S, Pandanaboyana S

Publication type: Review

Publication status: Published

Journal: HPB

Year: 2021

Volume: 23

Issue: 8

Pages: 1139-1151

Print publication date: 01/08/2021

Online publication date: 18/03/2021

Acceptance date: 25/02/2021

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.


DOI: 10.1016/j.hpb.2021.02.015