Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis

Background: In the past decades, the perioperative management of patients undergoing pancreaticoduo-denectomy (PD) has undergone major changes worldwide. This review aimed to systematically determine the burden of complications of PD performed in the last 10 years. Data sources: A systematic review was conducted in PubMed for randomized controlled trials and ob-servational studies reporting postoperative complications in at least 100 PDs from January 2010 to April 2020. Risk of bias was assessed using the Cochrane RoB2 tool for randomized studies and the method-ological index for non-randomized studies (MINORS). Pooled complication rates were estimated using random-effects meta-analysis. Heterogeneity was investigated by subgroup analysis and meta-regression. Results: A total of 20 randomized and 49 observational studies reporting 63 229 PDs were reviewed. Mean MINORS score showed a high risk of bias in non-randomized studies, while one quarter of the ran-domized studies were assessed to have high risk of bias. Pooled incidences of 30-day mortality, overall complications and serious complications were 1.7% (95% CI: 0.9%-2.9%; I 2 = 95.4%), 54.7% (95% CI: 46.4%- 62.8%; I 2 = 99.4%) and 25.5% (95% CI: 21.8%-29.4%; I 2 = 92.9%), respectively. Clinically-relevant postopera-tive pancreatic fistula risk was 14.3% (95% CI: 12.4%-16.3%; I 2 = 92.0%) and mean length of stay was 14.8 days (95% CI: 13.6-16.1; I 2 = 99.3%). Meta-regression partially attributed the observed heterogeneity to the country of origin of the study, the study design and the American Society of Anesthesiologists class. Conclusions: Pooled complication rates estimated in this study may be used to counsel patients scheduled to undergo a PD and to set benchmarks against which centers can audit their practice. However, cautious interpretation is necessary due to substantial heterogeneity. (c) 2022 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.