The Oncologic Impact of Pancreatic Fistula After Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma of the Body and the Tail: A Multicenter Retrospective Cohort Analysis

Leon, Piera; Giannone, Fabio; Belfiori, Giulio; Falconi, Massimo; Crippa, Stefano; Boggi, Ugo; Menonna, Francesca; Sadairi, Abdul Rahman Al; Piardi, Tullio; Sulpice, Laurent; Gardini, Andrea Casadei; Sega, Valentina; Chirica, Mircea; Ravazzoni, Ferruccio; Giannandrea, Giusy; Pessaux, Patrick; Blasi, Vito De; Navarro, Francis; Panaro, Fabrizio

doi:10.1245/s10434-020-09310-y

Cited by 6 publications

(17 citation statements)

References 34 publications

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“…The MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library searches yielded a total of 4045 citations ( Figure 1 ), and a consensus among all investigators led to 16 studies being judged as eligible for our meta-analysis [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Screening the references of the full-text articles assessed for eligibility revealed no further studies potentially suitable for inclusion.…”

Section: Resultsmentioning

confidence: 99%

“…Screening the references of the full-text articles assessed for eligibility revealed no further studies potentially suitable for inclusion. Eleven studies reporting DFS data (n = 3375 patients) [ 15 , 17 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 ] and sixteen studies containing information about OS (n = 5019 patients) were included in the meta-analysis [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] ( Figure 1 ). Correlation between long-term survival and POPF was assessed as the primary endpoint in 14 studied [ 14 , 15 , 16 , 17 , 18 , 19 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]; only two studies considered all complications [ 21 ] and the analysis of prognostic factors [ 20 ] as primary endpoints, and POPF impact as a secondary endpoint.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 16 retrospective cohort studies analyzed [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], 2 [ 19 , 29 ] were multicentric, and concerned a total of 5019 patients with an overall POPF rate of 20.78% (n = 1043 patients) and a CR-POPF rate of 12.63% (n = 634 patients). Table 1 and Supplementary Table S2 show the main characteristics of these studies.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 and Supplementary Table S2 show the main characteristics of these studies. Eleven of the sixteen studies reported patients’ ages (median or mean), which ranged from 61 to 71 years [ 15 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 29 ]. There was a male predominance in 12 of the 16 studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 ], with the proportion of males ranging from 51.6% [ 17 ] to 68.8% [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patients who underwent total pancreatectomy were not included in survival analysis in the two studies reporting these cases [ 21 , 23 ]. Four studies [ 14 , 17 , 22 , 25 ] only reported cases treated with pancreaticoduodenectomy, while Leon et al only examined patients who underwent distal pancreatectomy [ 29 ]. R0 resection rates were reported in 10 of the 16 studies [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], and ranged between 57.4% [ 25 ] and 94% in patients pretreated with neoadjuvant therapy (NAT) [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

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

Grego

Friziero

Serafini

et al. 2021

Cancers

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Background: The impact of postoperative pancreatic fistula (POPF) on survival after resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: The MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting on survival in patients with and without POPF. A meta-analysis was performed to investigate the impact of POPF on disease-free survival (DFS) and overall survival (OS). Results: Sixteen retrospective cohort studies concerning a total of 5019 patients with an overall clinically relevant POPF (CR-POPF) rate of 12.63% (n = 634 patients) were considered. Five of eleven studies including DFS data reported higher recurrence rates in patients with POPF, and one study showed a higher recurrence rate in the peritoneal cavity. Six of sixteen studies reported worse OS rates in patients with POPF. Sufficient data for a meta-analysis were available in 11 studies for DFS, and in 16 studies for OS. The meta-analysis identified a shorter DFS in patients with CR-POPF (HR 1.59, p = 0.0025), and a worse OS in patients with POPF, CR-POPF (HR 1.15, p = 0.0043), grade-C POPF (HR 2.21, p = 0.0007), or CR-POPF after neoadjuvant therapy. Conclusions: CR-POPF after resection for PDAC is significantly associated with worse overall and disease-free survival.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Grego

Friziero

Serafini

et al. 2021

Cancers

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Multi-visceral resection for left-sided pancreatic ductal adenocarcinoma: a multicenter retrospective analysis from European countries

Ferrari,

Leon,

Falconi

et al. 2023

Langenbecks Arch Surg

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Neoadjuvant Therapy for Pancreatic Cancer: Increased Use and Improved Optimal Outcomes

Davis

Beane²,

Gazivoda³

et al. 2022

Journal of the American College of Surgeons

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BACKGROUND: The introduction of more effective chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to assess the evolving use of NAT in individuals with PDAC undergoing pancreatoduodenectomy (PD) and to compare their outcomes with patients undergoing upfront operation. STUDY DESIGN: The American College of Surgeons NSQIP Procedure Targeted Pancreatectomy database was queried from 2014 to 2019. Patients undergoing pancreatoduodenectomy were evaluated based on the use of NAT versus upfront operation. Multivariable analysis was performed to determine the effect of NAT on postoperative outcomes, including the composite measure optimal pancreatic surgery (OPS). Mann-Kendall trend tests were performed to assess the use of NAT and associated outcomes over time. RESULTS: A total of 13,257 patients were identified who underwent PD for PDAC between 2014 and 2019. Overall, 33.6% of patients received NAT. The use of NAT increased steadily from 24.2% in 2014 to 42.7% in 2019 (p < 0.0001). On multivariable analysis, NAT was associated with reduced serious morbidity (odds ratio [OR] 0.83, p < 0.001), clinically relevant pancreatic fistulas (OR 0.52, p < 0.001), organ space infections (OR 0.74, p < 0.001), percutaneous drainage (OR 0.73, p < 0.001), reoperation (OR 0.76, p = 0.005), and prolonged length of stay (OR 0.63, p < 0.001). OPS was achieved more frequently in patients undergoing NAT (OR 1.433, p < 0.001) and improved over time in patients receiving NAT (50.7% to 56.6%, p < 0.001). CONCLUSION: NAT before pancreatoduodenectomy increased more than 3-fold over the past decade and was associated with improved optimal operative outcomes.

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The Oncologic Impact of Pancreatic Fistula After Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma of the Body and the Tail: A Multicenter Retrospective Cohort Analysis

Cited by 6 publications

References 34 publications

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

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

Multi-visceral resection for left-sided pancreatic ductal adenocarcinoma: a multicenter retrospective analysis from European countries

Neoadjuvant Therapy for Pancreatic Cancer: Increased Use and Improved Optimal Outcomes

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