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Perioperative interventions to reduce pancreatic fistula following pancreatoduodenectomy: meta-analysis

Lookup NU author(s): Darius Mirza, Sanjay PandanaboyanaORCiD


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© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: BACKGROUND: Data on interventions to reduce postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD) are conflicting. The aim of this study was to assimilate data from RCTs. METHODS: MEDLINE and Embase databases were searched systematically for RCTs evaluating interventions to reduce all grades of POPF or clinically relevant (CR) POPF after PD. Meta-analysis was undertaken for interventions investigated in multiple studies. A post hoc analysis of negative RCTs assessed whether these had appropriate statistical power. RESULTS: Among 22 interventions (7512 patients, 55 studies), 12 were assessed by multiple studies, and subjected to meta-analysis. Of these, external pancreatic duct drainage was the only intervention associated with reduced rates of both CR-POPF (odds ratio (OR) 0.40, 95 per cent c.i. 0.20 to 0.80) and all-POPF (OR 0.42, 0.25 to 0.70). Ulinastatin was associated with reduced rates of CR-POPF (OR 0.24, 0.06 to 0.93). Invagination (versus duct-to-mucosa) pancreatojejunostomy was associated with reduced rates of all-POPF (OR 0.60, 0.40 to 0.90). Most negative RCTs were found to be underpowered, with post hoc power calculations indicating that interventions would need to reduce the POPF rate to 1 per cent or less in order to achieve 80 per cent power in 16 of 34 (all-POPF) and 19 of 25 (CR-POPF) studies respectively. CONCLUSION: This meta-analysis supports a role for several interventions to reduce POPF after PD. RCTs in this field were often relatively small and underpowered, especially those evaluating CR-POPF.

Publication metadata

Author(s): Halle-Smith JM, Pande R, Hall L, Hodson J, Roberts KJ, Arshad A, Connor S, Conlon KCP, Dickson EJ, Giovinazzo F, Harrison E, de Liguori Carino N, Hore T, Knight SR, Loveday B, Magill L, Mirza D, Mitta A, Pandanaboyana S, Perry RJ, Pinkney T, Samra J, Siriwardena AK, Satoi S, Skipworth J, Stattner S, Sutcliffe RP, Tingstedt B, Roberts KJ

Publication type: Article

Publication status: Published

Journal: British Journal of Surgery

Year: 2022

Volume: 109

Issue: 9

Pages: 812-821

Print publication date: 01/09/2022

Online publication date: 22/06/2022

Acceptance date: 23/02/2022

ISSN (print): 0007-1323

ISSN (electronic): 1365-2168

Publisher: Oxford University Press


DOI: 10.1093/bjs/znac074

PubMed id: 35727956


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