Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Grego, Andrea; Friziero, Alberto; Serafini, Simone; Belluzzi, Amanda; Moletta, Lucia; Saadeh, Luca Maria; Sperti, Cosimo

doi:10.3390/cancers13225803

Cited by 12 publications

(8 citation statements)

References 42 publications

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“…TP-IAT should be further considered in light of the latest evidence of the impact of POPF on the long-term outcome. 40 , 41 In fact, TP may prevent a long-lasting decline of patients’ general condition associated with CR-POPF. This is particularly relevant in patients with adenocarcinoma, where a complicated clinical course may delay the start of adjuvant therapy, impacting oncological outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Our results further support this possibility, since IAT was able to provide partial insulin secretion in around 90% of patients undergoing TP, with good metabolic control (HbA1c level of ≤7.5%39) in 62% of subjects at last follow-up, without severe hypoglycemic episode or diabetes-related mortality. TP-IAT should be further considered in light of the latest evidence of the impact of POPF on the long-term outcome 40,41. In fact, TP may prevent a long-lasting decline of patients’ general condition associated with CR-POPF.…”

Section: Discussionmentioning

confidence: 99%

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Total Pancreatectomy With Islet Autotransplantation as an Alternative to High-risk Pancreatojejunostomy After Pancreaticoduodenectomy

et al. 2022

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Objective: To compare pancreaticoduodenectomy (PD) and total pancreatectomy (TP) with islet autotransplantation (IAT) in patients at high risk of postoperative pancreatic fistula (POPF). Background: Criteria to predict the risk of POPF occurrence after PD are available. However, even when a high risk of POPF is predicted, TP is not currently accepted as an alternative to PD, because of its severe consequences on glycaemic control. Combining IAT with TP may mitigate such consequences. Methods: Randomized, open-label, controlled, bicentric trial (NCT01346098). Candidates for PD at high-risk pancreatic anastomosis (ie, soft pancreas and duct diameter ≤3 mm) were randomly assigned (1:1) to undergo either PD or TP-IAT. The primary endpoint was the incidence of complications within 90 days after surgery. Results: Between 2010 and 2019, 61 patients were assigned to PD (n=31) or TP-IAT (n=30). In the intention-to-treat analysis, morbidity rate was 90·3% after PD and 60% after TP-IAT ( P =0.008). According to complications’ severity, PD was associated with an increased risk of grade ≥2 [odds ratio (OR)=7.64 (95% CI: 1.35–43.3), P =0.022], while the OR for grade ≥3 complications was 2.82 (95% CI: 0.86–9.24, P =0.086). After TP-IAT, the postoperative stay was shorter [median: 10.5 vs 16.0 days; P <0.001). No differences were observed in disease-free survival, site of recurrence, disease-specific survival, and overall survival. TP-IAT was associated with a higher risk of diabetes [hazard ratio=9.1 (95% CI: 3.76–21.9), P <0.0001], but most patients maintained good metabolic control and showed sustained C-peptide production over time. Conclusions: TP-IAT may become the standard treatment in candidates for PD, when a high risk of POPF is predicted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Total Pancreatectomy With Islet Autotransplantation as an Alternative to High-risk Pancreatojejunostomy After Pancreaticoduodenectomy

et al. 2022

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“…Other studies are in agreement with these results [48]. In a recent systematic review on the impact of POPF on long-term outcomes, only one study among sixteen found lower overall survival for patients with POPF [49]. Most of these studies used a Cox regression model, which does not take into account the baseline risk or the variation in mortality risk over time.…”

Section: Discussionmentioning

confidence: 67%

Influence of Hemorrhagic Complications of Pancreatoduodenectomy in Patients with Cancer on Short- and Long-Term Mortality

Thobie

Robin²,

Menahem

et al. 2023

JCM

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Background: With a mortality rate of up to 30%, post-pancreatectomy hemorrhage (PPH) remains a serious complication after pancreatoduodenectomy (PD) for cancer. Little is known about the long-term survival of patients after PPH. This retrospective study aimed to evaluate the impact of PPH on long-term survival after PD. Methods: The study included 830 patients (PPH, n = 101; non-PPH, n = 729) from two centers, who underwent PD for oncological indications. PPH was defined as any bleeding event occurring within 90 days after surgery. A flexible parametric survival model was used to determine the evolution of the risk of death over time. Results: At postoperative day 90, PPH significantly increased the mortality rate (PPH vs. non-PPH: 19.8% vs. 3.7%, p < 0.0001) and severe postoperative complication rate (85.1% vs. 14.1%, p < 0.0001), and decreased median survival (18.6 months vs. 30.1 months, p = 0.0001). PPH was associated with an increased mortality risk until the sixth postoperative month. After this 6-month period, PPH had no more influence on mortality. Conclusions: PPH had a negative impact on the short-term overall survival beyond postoperative day 90 and up to six months after PD. However, compared to non-PPH patients, this adverse event had no impact on mortality after a 6-month period.

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“…Clinically relevant postoperative pancreatic fistula (CR-POPF) is a feared complication following pancreatoduodenectomy that negatively impacts short- and long-term outcomes 1 , 2 . Accurate risk stratification of CR-POPF in the preoperative setting can assist in determining the best surgical approach for high-risk or frail patients.…”

Section: Introductionmentioning

confidence: 99%

Radiomics preoperative-Fistula Risk Score (RAD-FRS) for pancreatoduodenectomy: development and external validation

Ingwersen,

Bereska,

Balduzzi

et al. 2023

BJS Open

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Background Accurately predicting the risk of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy before surgery may assist surgeons in making more informed treatment decisions and improved patient counselling. The aim was to evaluate the predictive accuracy of a radiomics-based preoperative-Fistula Risk Score (RAD-FRS) for clinically relevant postoperative pancreatic fistula. Methods Radiomic features were derived from preoperative CT scans from adult patients after pancreatoduodenectomy at a single centre in the Netherlands (Amsterdam, 2013–2018) to develop the radiomics-based preoperative-Fistula Risk Score. Extracted radiomic features were analysed with four machine learning classifiers. The model was externally validated in a single centre in Italy (Verona, 2020–2021). The radiomics-based preoperative-Fistula Risk Score was compared with the Fistula Risk Score and the updated alternative Fistula Risk Score. Results Overall, 359 patients underwent a pancreatoduodenectomy, of whom 89 (25 per cent) developed a clinically relevant postoperative pancreatic fistula. The radiomics-based preoperative-Fistula Risk Score model was developed using CT scans of 118 patients, of which three radiomic features were included in the random forest model, and externally validated in 57 patients. The model performed well with an area under the curve of 0.90 (95 per cent c.i. 0.71 to 0.99) and 0.81 (95 per cent c.i. 0.69 to 0.92) in the Amsterdam test set and Verona data set respectively. The radiomics-based preoperative-Fistula Risk Score performed similarly to the Fistula Risk Score (area under the curve 0.79) and updated alternative Fistula Risk Score (area under the curve 0.79). Conclusion The radiomics-based preoperative-Fistula Risk Score, which uses only preoperative CT features, is a new and promising radiomics-based score that has the potential to be integrated with hospital CT report systems and improve patient counselling before surgery. The model with underlying code is readily available via www.pancreascalculator.com and www.github.com/PHAIR-Consortium/POPF-predictor.

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Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Cited by 12 publications

References 42 publications

Total Pancreatectomy With Islet Autotransplantation as an Alternative to High-risk Pancreatojejunostomy After Pancreaticoduodenectomy

Total Pancreatectomy With Islet Autotransplantation as an Alternative to High-risk Pancreatojejunostomy After Pancreaticoduodenectomy

Influence of Hemorrhagic Complications of Pancreatoduodenectomy in Patients with Cancer on Short- and Long-Term Mortality

Radiomics preoperative-Fistula Risk Score (RAD-FRS) for pancreatoduodenectomy: development and external validation

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