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

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

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.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow diagram illustrating selection of the articles included in the meta-analysis.
Figure 2
Figure 2
Forest plot of the association between POPF and non-operation related risk factors. (A) The association between POPF and age. (B) The association between POPF and BMI. (C) The association between POPF and history of chronic pancreatitis.
Figure 3
Figure 3
Forest plot of the association between POPF and operation related risk factors. (A) The association between POPF and pancreas texture. (B) The association between POPF and blood transfusion. (C) The association between POPF and intraoperative blood loss. (D) The association between POPF and operative time. (E) The association between POPF and splenectomy. (F) The association between POPF and main duct ligation.

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