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Surgical methods influence on the risk of anastomotic fistula after pancreaticoduodenectomy: a systematic review and network meta-analysis

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Abstract

Background

Pancreaticoduodenectomy is the first choice surgical intervention for the radical treatment of pancreatic tumors. However, an anastomotic fistula is a common complication after pancreaticoduodenectomy with a high mortality rate. With the development of minimally invasive surgery, open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD) are gaining interest. But the impact of these surgical methods on the risk of anastomosis has not been confirmed. Therefore, we aimed to integrate relevant clinical studies and explore the effects of these three surgical methods on the occurrence of anastomotic fistula after pancreaticoduodenectomy.

Methods

A systematic literature search was conducted for studies reporting the RPD, LPD, and OPD. Network meta-analysis of postoperative anastomotic fistula (Pancreatic fistula, biliary leakage, gastrointestinal fistula) was performed.

Results

Sixty-five studies including 10,026 patients were included in the network meta-analysis. The rank of risk probability of pancreatic fistula for RPD (0.00) was better than LPD (0.37) and OPD (0.62). Thus, the analysis suggests the rank of risk of the postoperative pancreatic fistula for RPD, LPD, and OPD. The rank of risk probability for biliary leakage was similar for RPD (0.15) and LPD (0.15), and both were better than OPD (0.68).

Conclusions

This network meta-analysis provided ranking for three different types of pancreaticoduodenectomy. The RPD and LPD can effectively improve the quality of surgery and are safe as well as feasible for OPD.

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Acknowledgements

The authors would like to thank all the reviewers and editors who participated in the review and MJEditor (www.mjeditor.com) for its linguistic assistance during the preparation of this manuscript.

Funding

This work was supported by Natural Science Foundation of Jilin Province Science and Technology Department (20190201054JC).

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Author notes

  1. Kun Wang and Shan-shan Dong are the co-first authors and have equally contributed to this work.

Authors and Affiliations

  1. Department of Pediatric Respiration, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China

    Kun Wang

  2. Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China

    Shan-shan Dong

  3. School of Nursing, Jilin University, Changchun, 130000, Jilin Province, China

    Wei Zhang, Yuan-yuan Ni, Fang Xie, Jun-chao Wang & Xing-hui Wang

  4. School of Nursing, Jilin University, No. 965 Xinjiang Street, Chaoyang District, Changchun, 130021, Jilin Province, China

    Yue-wei Li

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Contributions

Y-WL, S-SD, and KW contributed toward conception and design. None contributed toward administrative support. None contributed toward provision of study materials or patients. Y-WL and S-SD contributed toward collection and assembly of data. Y-WL, S-SD, and KW contributed toward data analysis and interpretation. All authors contributed toward manuscript writing. All authors contributed toward final approval of manuscript.

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Correspondence to Yue-wei Li.

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Drs. Shan-shan Dong, Kun Wang, Wei Zhang, Yuan-yuan Ni, Fang Xie, Jun-chao Wang, Xing-hui Wang, and Yue-wei Li have no conflicts of interest or financial ties to disclose.

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Wang, K., Dong, Ss., Zhang, W. et al. Surgical methods influence on the risk of anastomotic fistula after pancreaticoduodenectomy: a systematic review and network meta-analysis. Surg Endosc 37, 3380–3397 (2023). https://doi.org/10.1007/s00464-022-09832-4

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