Association of preoperative CT-scan features and clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: a meta-analysis
Ahmad Madankan MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Conceptualization, Data curation, Project administration, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorCorresponding Author
Ali Jaliliyan MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Correspondence
Dr. Ali Jaliliyan, Department of General Surgery, Hazrat-e Rasool General Hospital Niyayesh Street, Tehran, Iran. Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Project administration, Resources, Writing - original draft, Writing - review & editing
Search for more papers by this authorPantea Khalili MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Data curation, Investigation, Writing - original draft, Writing - review & editing
Search for more papers by this authorShayan Eghdami MD, MPH
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Formal analysis, Methodology, Validation, Visualization, Writing - original draft
Search for more papers by this authorHesam Mosavari MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Data curation, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorSeyyed Amir Yasin Ahmadi MD
Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
Contribution: Formal analysis, Methodology, Validation, Visualization
Search for more papers by this authorAmirreza Izadi MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorAli Hosseininasab MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorFoolad Eghbali MD, FIFSO
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorAhmad Madankan MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Conceptualization, Data curation, Project administration, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorCorresponding Author
Ali Jaliliyan MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Correspondence
Dr. Ali Jaliliyan, Department of General Surgery, Hazrat-e Rasool General Hospital Niyayesh Street, Tehran, Iran. Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Project administration, Resources, Writing - original draft, Writing - review & editing
Search for more papers by this authorPantea Khalili MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Data curation, Investigation, Writing - original draft, Writing - review & editing
Search for more papers by this authorShayan Eghdami MD, MPH
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Formal analysis, Methodology, Validation, Visualization, Writing - original draft
Search for more papers by this authorHesam Mosavari MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Data curation, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorSeyyed Amir Yasin Ahmadi MD
Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
Contribution: Formal analysis, Methodology, Validation, Visualization
Search for more papers by this authorAmirreza Izadi MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorAli Hosseininasab MD
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorFoolad Eghbali MD, FIFSO
Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorAbstract
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.
Conflicts of interest
The authores declare that there are no conflicts of interest regarding the publication of this paper. No funding, financial interest, or personal relationship could have influenced the work reported in this study.
Supporting Information
| Filename | Description |
|---|---|
| ans19033-sup-0001-DocS1.docxWord 2007 document , 21.5 KB | Data S1. Prisma Checklist. |
| ans19033-sup-0002-DocS2.docxWord 2007 document , 14.5 KB | Data S2. Search strategy. |
| ans19033-sup-0003-DocS3.docxWord 2007 document , 16.5 KB | Data S3. CT-Scan features assessment protocols. |
| ans19033-sup-0004-DocS4.docxWord 2007 document , 34.5 KB | Data S4. Statistical analysis methods in detail. |
| ans19033-sup-0005-FigureS1.jpgJPEG image, 14.8 KB | Figure S1. Funnel plot of the mean difference of PAI effect on CR-POPF. |
| ans19033-sup-0006-FigureS2.jpgJPEG image, 21.6 KB | Figure S2. Funnel plot of the mean difference of PTT effect on CR-POPF. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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