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Lookup NU author(s): Darius Mirza, Professor Sanjay PandanaboyanaORCiD
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© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 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.
Author(s): Halle-Smith JM, Pande R, Hall L, Hodson J, Roberts KJ, Arshad A, Connor S, Conlon KCP, Dickson EJ, Giovinazzo F, Harrison E, de Liguori Carino N, Hore T, Knight SR, Loveday B, Magill L, Mirza D, Mitta A, Pandanaboyana S, Perry RJ, Pinkney T, Samra J, Siriwardena AK, Satoi S, Skipworth J, Stattner S, Sutcliffe RP, Tingstedt B, Roberts KJ
Publication type: Article
Publication status: Published
Journal: British Journal of Surgery
Year: 2022
Volume: 109
Issue: 9
Pages: 812-821
Print publication date: 01/09/2022
Online publication date: 22/06/2022
Acceptance date: 23/02/2022
ISSN (print): 0007-1323
ISSN (electronic): 1365-2168
Publisher: Oxford University Press
URL: https://doi.org/10.1093/bjs/znac074
DOI: 10.1093/bjs/znac074
PubMed id: 35727956
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