Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

Yun-Peng Peng,Yun-Peng Peng,Ji-Shu Wei,Ji-Shu Wei,Jun-Li Wu,Jun-Li Wu,Yi Miao,Yi Miao,Yi Zhu,Yi Zhu,Xiao-Le Zhu,Ling-Di Yin,Ling-Di Yin

doi:10.1038/s41598-017-00311-8

Abstract

Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). However, the risk factors of this complication in patients after DP still remain controversial. The aim of our study is to estimate the association between potential risk factors and POPF. Relevant articles published up to June 21, 2016 were identified via PubMed, EMBASE, Web of Science, and The Cochrane Library. Studies that examined the risk factors of POPF following DP were enrolled. 20 articles (2070 patients) were finally included in this study. The pooled data suggested that patients with soft pancreas, higher Body Mass Index (BMI), blood transfusion, elevated intraoperative blood loss, and longer operative time had a decreased risk for POPF. However, age, gender, malignant pathology, types of stump closure, octreotide therapy, history of diabetes and chronic pancreatitis, splenectomy, multiorgan resection, main duct ligation, preoperative serum albumin levels, PGA felt wrapping, and extended lymphadenectomy could not be regarded as risk factors for POPF. Our analytic data demonstrated that pancreas texture, BMI, blood transfusion, intraoperative blood loss, and operative time were clinical predictor for POPF. This study may assist surgeons to screen patients with high risk of POPF and select appropriate treatment measures.

Highlights

Pancreatic fistula is still a ongoing clinical problem following pancreatic resection, with various technical innovation failing to reduce the occurrence of such complication[33]
To the best of our knowledge, this is the first meta analysis to assess the association between several risk factors and POPF comprehensively
According to the combined ORs and 95% CIs, we confirmed that patients with soft pancreas, higher BMI, blood transfusion, a large number of intraoperative blood loss, and extended operative time were prone to suffer from POPF

Summary

Introduction

As reported in some studies, a large number of factors could heighten the risk of POPF, such as older age, increased BMI, diabetes history, soft pancreas preoperative blood transfusion, elevated intraoperative blood loss, and longer operative time[7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32].

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Conclusion