Pancreas Center, The First Affiliated Hospital of Nanjing Medical University.
Pancreas Institute, Nanjing Medical University.
Int J Surg. 2023 Jul 1;109(7):2096-2119. doi: 10.1097/JS9.0000000000000418.
Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD). However, its risk factors are still unclear. This meta-analysis aimed to identify the potential risk factors of DGE among patients undergoing PD or PPPD.
We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrial.gov for studies that examined the clinical risk factors of DGE after PD or PPPD from inception through 31 July 2022. We pooled odds ratios (ORs) with 95% CIs using random-effects or fixed-effects models. We also performed heterogeneity, sensitivity, and publication bias analyses.
The study included a total of 31 research studies, which involved 9205 patients. The pooled analysis indicated that out of 16 nonsurgical-related risk factors, three risk factors were found to be associated with an increased incidence of DGE. These risk factors were older age (OR 1.37, P =0.005), preoperative biliary drainage (OR 1.34, P =0.006), and soft pancreas texture (OR 1.23, P =0.04). On the other hand, patients with dilated pancreatic duct (OR 0.59, P =0.005) had a decreased risk of DGE. Among 12 operation-related risk factors, more blood loss (OR 1.33, P =0.01), postoperative pancreatic fistula (POPF) (OR 2.09, P <0.001), intra-abdominal collection (OR 3.58, P =0.001), and intra-abdominal abscess (OR 3.06, P <0.0001) were more likely to cause DGE. However, our data also revealed 20 factors did not support stimulative factors influencing DGE.
Age, preoperative biliary drainage, pancreas texture, pancreatic duct size, blood loss, POPF, intra-abdominal collection, and intra-abdominal abscess are significantly associated with DGE. This meta-analysis may have utility in guiding clinical practice for improvements in screening patients with a high risk of DGE and selecting appropriate treatment measures.
胃排空延迟（DGE）是胰十二指肠切除术（PD）或保留幽门的胰十二指肠切除术（PPPD）后的常见并发症。然而，其危险因素仍不清楚。本荟萃分析旨在确定 PD 或 PPPD 术后发生 DGE 的潜在危险因素。
我们检索了 PubMed、EMBASE、Web of Science、Cochrane 图书馆、Google Scholar 和 ClinicalTrials.gov，以查找从研究开始至 2022 年 7 月 31 日期间研究 PD 或 PPPD 后 DGE 临床危险因素的研究。我们使用随机效应或固定效应模型汇总了优势比（OR）及其 95%置信区间（CI）。我们还进行了异质性、敏感性和发表偏倚分析。
该研究共纳入 31 项研究，涉及 9205 名患者。荟萃分析表明，在 16 个非手术相关危险因素中，有 3 个危险因素与 DGE 发生率增加相关。这些危险因素包括年龄较大（OR 1.37，P=0.005）、术前胆道引流（OR 1.34，P=0.006）和胰腺质地柔软（OR 1.23，P=0.04）。另一方面，胰管扩张（OR 0.59，P=0.005）的患者 DGE 风险降低。在 12 个手术相关危险因素中，出血量较多（OR 1.33，P=0.01）、术后胰瘘（POPF）（OR 2.09，P<0.001）、腹腔积液（OR 3.58，P=0.001）和腹腔脓肿（OR 3.06，P<0.0001）更易导致 DGE。然而，我们的数据还表明，20 个因素不支持刺激因素影响 DGE。
年龄、术前胆道引流、胰腺质地、胰管大小、出血量、POPF、腹腔积液和腹腔脓肿与 DGE 显著相关。本荟萃分析可能有助于指导临床实践，以改善对 DGE 高危患者的筛查，并选择合适的治疗措施。
