Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle-Upon-Tyne, UK.
Institute of Cellular Medicine, University of Newcastle, Newcastle-Upon-Tyne, UK.
ANZ J Surg. 2021 May;91(5):810-821. doi: 10.1111/ans.16408. Epub 2020 Nov 2.
Many studies have explored factors relating to post-operative pancreatic fistula (POPF); however, the original definition (All-POPF) was revised to include only 'clinically relevant' (CR) POPF. This study identified variables associated with the two International Study Group on Pancreatic Surgery definitions to identify which variables are more strongly associated with CR-POPF.
A systematic review identified all studies reporting risk factors for POPF (using both International Study Group on Pancreatic Fistula definitions) following pancreatoduodenectomy. The primary outcome was factors associated with CR-POPF. Meta-analyses (random effects models) of pre-, intra- and post-operative factors associated with POPF in more than two studies were included.
Among 52 774 patients All-POPF (n = 69 studies) and CR-POPF (n = 53 studies) affected 27% (95% confidence interval (CI ) 23-30) and 19% (CI 17-22), respectively. Of the 176 factors, 24 and 17 were associated with All- and CR-POPF, respectively. Absence of pre-operative pancreatitis, presence of renal disease, no pre-operative neoadjuvant therapy, use of post-operative somatostatin analogues, absence of associated venous or arterial resection were associated with CR-POPF but not All-POPF.
In conclusion this study demonstrates wide variation in reported rates of POPF and that several risk factors associated with CR-POPF are not used within risk prediction models. Data from this study can be used to shape future studies, research and audit across ethnic and geographic boundaries in POPF following pancreatoduodenectomy.
许多研究都探讨了与术后胰瘘（POPF）相关的因素；然而，原始定义（所有 POPF）已被修订，仅包括“临床相关”（CR）POPF。本研究确定了与国际胰腺外科研究组两个定义相关的变量，以确定哪些变量与 CR-POPF 更密切相关。
系统综述确定了所有报告胰十二指肠切除术后胰瘘（使用国际胰腺瘘研究组定义）风险因素的研究。主要结局是与 CR-POPF 相关的因素。纳入了超过两项研究报告与 POPF 相关的术前、术中及术后因素的荟萃分析（随机效应模型）。
在 52774 例患者中，全 POPF（n=69 项研究）和 CR-POPF（n=53 项研究）分别影响了 27%（95%置信区间 23-30）和 19%（95%置信区间 17-22）。在 176 个因素中，有 24 个和 17 个与全 POPF 和 CR-POPF 相关。术前无胰腺炎、存在肾脏疾病、无术前新辅助治疗、术后使用生长抑素类似物、无静脉或动脉切除与 CR-POPF 相关，但与全 POPF 无关。
总之，本研究表明，报告的 POPF 发生率存在广泛差异，并且与 CR-POPF 相关的几个风险因素未被用于风险预测模型中。本研究的数据可用于指导未来的研究、研究和审核，跨越种族和地理界限，研究胰十二指肠切除术后的 POPF。
