Kokkinakis, S., Kritsotakis, E.I. orcid.org/0000-0002-9526-3852, Maliotis, N. et al. (3 more authors) (2022) Complications of modern pancreaticoduodenectomy: a systematic review and meta-analysis. Hepatobiliary & Pancreatic Diseases International, 21 (6). pp. 527-537. ISSN 1499-3872
Abstract
Background
In the past decades, the perioperative management of patients undergoing pancreaticoduodenectomy (PD) has undergone major changes worldwide. This review aimed to systematically determine the burden of complications of PD performed in the last 10 years.
Data sources
A systematic review was conducted in PubMed for randomized controlled trials and observational studies reporting postoperative complications in at least 100 PDs from January 2010 to April 2020. Risk of bias was assessed using the Cochrane RoB2 tool for randomized studies and the methodological index for non-randomized studies (MINORS). Pooled complication rates were estimated using random-effects meta-analysis. Heterogeneity was investigated by subgroup analysis and meta-regression.
Results
A total of 20 randomized and 49 observational studies reporting 63 229 PDs were reviewed. Mean MINORS score showed a high risk of bias in non-randomized studies, while one quarter of the randomized studies were assessed to have high risk of bias. Pooled incidences of 30-day mortality, overall complications and serious complications were 1.7% (95% CI: 0.9%–2.9%; I2 = 95.4%), 54.7% (95% CI: 46.4%–62.8%; I2 = 99.4%) and 25.5% (95% CI: 21.8%–29.4%; I2= 92.9%), respectively. Clinically-relevant postoperative pancreatic fistula risk was 14.3% (95% CI: 12.4%–16.3%; I2 = 92.0%) and mean length of stay was 14.8 days (95% CI: 13.6–16.1; I2 = 99.3%). Meta-regression partially attributed the observed heterogeneity to the country of origin of the study, the study design and the American Society of Anesthesiologists class.
Conclusions
Pooled complication rates estimated in this study may be used to counsel patients scheduled to undergo a pancreaticoduodenectomy and to set benchmarks against which centers can audit their practice. However, cautious interpretation is necessary due to substantial heterogeneity.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. This is an author produced version of a paper subsequently published in Hepatobiliary & Pancreatic Diseases International. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Pancreaticoduodenectomy; Postoperative complications; Meta-analysis; Postoperative pancreatic fistula |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 06 Oct 2022 11:33 |
Last Modified: | 28 Jun 2024 11:56 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.hbpd.2022.04.006 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:191330 |
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