Khan Mustafa Ali, Sherwani Maryam, Ahmed Kaleem S, Ali Mubeen, Kumar Priya Ashok, Tariq Javeria, Christensen Leslie, Bogale Netsanet, Schwartz Patrick B, Zafar Syed Nabeel
Medical College, Aga Khan University, Karachi, Pakistan.
Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA.
J Surg Oncol. 2025 Mar;131(3):435-442. doi: 10.1002/jso.27946. Epub 2024 Oct 23.
Measuring postoperative outcomes after complex cancer operations such as pancreatectomy is vital to improve cancer surgery in low- and middle-income countries (LMICs); however, such data is often limited. This study aimed to review existing research and obtain baseline estimates for postoperative mortality and morbidity after pancreatic cancer surgery in LMICs.
PubMed, Embase, Web of Science Core Collection, and Global Index Medicus were systematically searched for original articles published between January 2005 and May 2022. LMICs based studies reporting postoperative mortality, morbidity, and/or length of stay of patients with primary pancreatic tumors undergoing pancreaticoduodenectomy and/or distal pancreatectomy were included.
Of 18 344 unique titles and abstracts retrieved, 114 studies met the inclusion criteria. Of these, 51 "good" quality studies comprising 7528 patients were included in the meta-analyses. Pooled estimates for pancreatic fistula were 16.6% (95% CI 14.0-19.7, p < 0.001); 16.0% (95% CI 11.1-22.5, p < 0.001) for Clavien-Dindo grade 3 and 4 complications; 13.4% (95% CI 9.8-17.9, p < 0.001) for wound infection; and 4.4% (95% CI 3.3-5.7, p < 0.001) for postoperative mortality.
This is the first systematic review and meta-analysis examining surgical complications after pancreatic surgery in LMICs. We highlight a lack of data and the need to further evaluate surgical outcomes in LMICs.
对于中低收入国家（LMICs）而言，测量诸如胰腺切除术等复杂癌症手术后的术后结果对于改善癌症手术至关重要；然而，此类数据往往有限。本研究旨在回顾现有研究，并获取中低收入国家胰腺癌手术后的术后死亡率和发病率的基线估计值。
系统检索了PubMed、Embase、科学引文索引核心合集和全球医学索引，以查找2005年1月至2022年5月期间发表的原创文章。纳入基于中低收入国家的研究，这些研究报告了接受胰十二指肠切除术和/或远端胰腺切除术的原发性胰腺肿瘤患者的术后死亡率、发病率和/或住院时间。
在检索到的18344个独特标题和摘要中，有114项研究符合纳入标准。其中，51项“高质量”研究（共7528例患者）被纳入荟萃分析。胰瘘的合并估计值为16.6%（95%置信区间14.0 - 19.7，p < 0.001）；Clavien-Dindo 3级和4级并发症为16.0%（95%置信区间11.1 - 22.5，p < 0.001）；伤口感染为13.4%（95%置信区间9.8 - 17.9，p < 0.001）；术后死亡率为4.4%（95%置信区间3.3 - 5.7，p < 0.001）。
这是第一项对中低收入国家胰腺手术后手术并发症进行的系统评价和荟萃分析。我们强调了数据的缺乏以及进一步评估中低收入国家手术结果的必要性。
