Impact of postoperative pancreatic fistula (POPF) on long-term outcomes of patients who underwent pancreatic cancer resection: systematic review and meta-analysis.

INTRODUCTION

Postoperative pancreatic fistula (POPF) is a major complication resulting from pancreatic resection. The long-term oncological outcomes of patients who experience POPF after pancreatic cancer resection remain inconclusive. The purpose of this study was to evaluate the impact of POPF on the long-term survival of patients undergoing pancreatic cancer resection.

METHODS

A systematic review and meta-analysis were performed for studies comparing survival outcomes in patients with or without POPF following pancreatic cancer resection.

RESULTS

Eighteen studies were included in the systematic review comprising a total of 7919 patients. The pooled incidences of POPF (ISGPF 2005 definition) and clinically-relevant (CR-POPF; ISGPF 2016 definition) were 20% and 14%, respectively. The presence of CR-POPF was significantly associated with worse recurrence-free survival (HR 1.60, 95% CI 1.01-2.53). In contrast, its association on overall survival was limited to grade C POPF (HR 1.81, 95% CI 1.10-2.99). Patients with POPF were also less likely to receive adjuvant chemotherapy (RR 0.76, 95% CI 0.60-0.97, p = 0.03). POPF was not associated with increased risk of locoregional (RR 1.29, 95%CI 0.77-2.17, p = 0.18) or peritoneal recurrence (RR 0.86, 95%CI 0.63-1.19, p = 0.59).

CONCLUSIONS

CR-POPF is significantly associated with cancer recurrence after pancreatic resection. However, its effect on overall survival is largely confined to the most severe grade C POPF. Although POPF decreases the likelihood of receiving adjuvant chemotherapy, the association of POPF on the peritoneal or locoregional recurrence remains inconclusive due to limited studies. These findings are suggestive of the importance to prevent severe fistulas.