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Perioperative inter...
Perioperative interventions to reduce pancreatic fistula following pancreatoduodenectomy : meta-analysis
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- Halle-Smith, James M. (author)
- New Queen Elizabeth Hospital
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- Pande, Rupaly (author)
- New Queen Elizabeth Hospital
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- Hall, Lewis (author)
- New Queen Elizabeth Hospital
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- Hodson, James (author)
- New Queen Elizabeth Hospital
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- Roberts, Keith J. (author)
- New Queen Elizabeth Hospital,University of Birmingham
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- Arshad, Ali (author)
- University Hospital Southampton
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- Connor, Saxon (author)
- Christchurch Hospital New Zealand
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- Conlon, Kevin C.P. (author)
- Trinity College Dublin
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- Dickson, Euan J. (author)
- Glasgow Royal Infirmary
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- Giovinazzo, Francesco (author)
- Policlinico Universitario Agostino Gemelli
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- Harrison, Ewen (author)
- University of Edinburgh
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- de Liguori Carino, Nicola (author)
- Manchester University NHS Foundation Trust
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- Hore, Todd (author)
- Christchurch Hospital New Zealand
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- Knight, Stephen R. (author)
- University of Edinburgh
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- Loveday, Benjamin (author)
- Royal Melbourne Hospital
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- Magill, Laura (author)
- University of Birmingham
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- Mirza, Darius (author)
- New Queen Elizabeth Hospital
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- Mitta, Anubhav (author)
- Royal North Shore Hospital
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- Pandanaboyana, Sanjay (author)
- Freeman Hospital
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- Perry, Rita J. (author)
- University of Birmingham
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- Pinkney, Thomas (author)
- University of Birmingham
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- Samra, Jas (author)
- Royal North Shore Hospital
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- Siriwardena, Ajith K. (author)
- Manchester University NHS Foundation Trust
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- Satoi, Sohei (author)
- Kansai Medical University,University of Colorado
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- Skipworth, James (author)
- University Hospitals Bristol NHS Foundation Trust
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Stättner, Stefan (author)
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- Sutcliffe, Robert P. (author)
- New Queen Elizabeth Hospital
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- Tingstedt, Bobby (author)
- Lund University,Lunds universitet,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups
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(creator_code:org_t)
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- 2022-06-21
- 2022
- English 10 s.
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In: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 109:9, s. 812-821
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
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- BACKGROUND: Data on interventions to reduce postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD) are conflicting. The aim of this study was to assimilate data from RCTs. METHODS: MEDLINE and Embase databases were searched systematically for RCTs evaluating interventions to reduce all grades of POPF or clinically relevant (CR) POPF after PD. Meta-analysis was undertaken for interventions investigated in multiple studies. A post hoc analysis of negative RCTs assessed whether these had appropriate statistical power. RESULTS: Among 22 interventions (7512 patients, 55 studies), 12 were assessed by multiple studies, and subjected to meta-analysis. Of these, external pancreatic duct drainage was the only intervention associated with reduced rates of both CR-POPF (odds ratio (OR) 0.40, 95 per cent c.i. 0.20 to 0.80) and all-POPF (OR 0.42, 0.25 to 0.70). Ulinastatin was associated with reduced rates of CR-POPF (OR 0.24, 0.06 to 0.93). Invagination (versus duct-to-mucosa) pancreatojejunostomy was associated with reduced rates of all-POPF (OR 0.60, 0.40 to 0.90). Most negative RCTs were found to be underpowered, with post hoc power calculations indicating that interventions would need to reduce the POPF rate to 1 per cent or less in order to achieve 80 per cent power in 16 of 34 (all-POPF) and 19 of 25 (CR-POPF) studies respectively. CONCLUSION: This meta-analysis supports a role for several interventions to reduce POPF after PD. RCTs in this field were often relatively small and underpowered, especially those evaluating CR-POPF.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Halle-Smith, Jam ...
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Pande, Rupaly
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Hall, Lewis
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Hodson, James
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Roberts, Keith J ...
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Arshad, Ali
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Connor, Saxon
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Conlon, Kevin C. ...
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Dickson, Euan J.
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Giovinazzo, Fran ...
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Harrison, Ewen
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de Liguori Carin ...
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Hore, Todd
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Knight, Stephen ...
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Loveday, Benjami ...
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Magill, Laura
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Mirza, Darius
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Mitta, Anubhav
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Pandanaboyana, S ...
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Perry, Rita J.
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Pinkney, Thomas
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Samra, Jas
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Siriwardena, Aji ...
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Satoi, Sohei
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Skipworth, James
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Stättner, Stefan
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Sutcliffe, Rober ...
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Tingstedt, Bobby
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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The British jour ...
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Lund University