Association of preoperative CT‐scan features and clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: a meta‐analysis

• Published in: ANZ journal of surgery 2024-06, Vol.94 (6), p.1030-1038
• Main Authors: Madankan, Ahmad, Jaliliyan, Ali, Khalili, Pantea, Eghdami, Shayan, Mosavari, Hesam, Ahmadi, Seyyed Amir Yasin, Izadi, Amirreza, Hosseininasab, Ali, Eghbali, Foolad
• Format: Article
• Language: English
• Subjects: Case reports; Cohort analysis; complication prediction; Computed tomography; Fistula; Fistulae; hepatopancreaticobiliary surgery; Humans; Incidence; Medical imaging; Meta-analysis; Pancreas; Pancreatic Fistula - diagnostic imaging; Pancreatic Fistula - epidemiology; Pancreatic Fistula - etiology; Pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; postoperative pancreatic fistula; Preoperative Period; Quality assessment; Quality control; Regression analysis; Reviews; Risk Factors; Statistical analysis; surgical oncology; Systematic review; Thickness; Tomography, X-Ray Computed - methods; Whipple surgery
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.19033

Background Clinically relevant postoperative pancreatic fistula (CR‐POPF) is a significant complication after pancreaticoduodenectomy. CR‐POPF is associated with various adverse outcomes, including high mortality rates. Identifying complication predictors for CR‐POPF, such as preoperative CT scan features, including pancreatic attenuation index (PAI) and pancreatic duct diameter (PDD), is critical. This systematic review and meta‐analysis consolidate existing literature to assess the impact of these variables on CR‐POPF risk. Methods Our comprehensive search, conducted in May 2023, covered PubMed, Scopus, Embase, and Web of Science databases. Inclusion criteria encompassed peer‐reviewed cohort studies on pancreaticoduodenectomy, focusing on preoperative CT scan data. Case reports, case series, and studies reporting distal pancreatectomy were excluded. The quality assessment of included articles was done using New‐Castle Ottawa Scale for cohort studies. Statistical analysis was carried out using Review Manager 5. This study was registered at the International Prospective Register of Systematic Reviews database (PROSPERO) on 12 May 2023 (registration number: CRD42023414139). Results We conducted a detailed analysis of 38 studies with 7393 participants. The overall incidence of CR‐POPF was 24%. Multiple linear regression analyses revealed that PDD and pancreatic parenchymal thickness were significantly associated with CR‐POPF. Conclusion Our systematic review and meta‐analysis shed light on CT scan findings for predicting CR‐POPF after Whipple surgery. Age, PDD, and pancreatic parenchymal thickness significantly correlate with CR‐POPF. This systematic review and meta‐analysis of 38 studies found that smaller pancreatic duct diameter (PDD) and decreased pancreatic parenchymal thickness (PPT) on preoperative CT scans are significant predictors of clinically relevant postoperative pancreatic fistula (CR‐POPF) after pancreaticoduodenectomy. Age also correlates with an increased risk of this complication.