Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025
Obesity is a major risk factor for adverse outcomes following Pancreatectomy: Results of a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Hajibandeh Shahin, Westerman Robyn, Ali Esha Tr, Hajibandeh Shahab, Raza Syed Soulat, Bartlett David C, Chatzizacharias Nikolaos, Dasari Bobby Vm, Marudanayagam Ravi, Roberts Keith J, Sutcliffe Robert P
Аннотация
AIMS: To evaluate comparative outcomes of pancreatic resection in patients with or without obesity.
METHODS: A systematic search of electronic data sources and bibliographic reference lists were conducted. All studies reporting comparative outcomes of pancreatic resections in patients with versus without obesity (Body Mass Index (BMI)≥30 kg/m2) were included and their risk of bias were assessed. Clinically-relevant postoperative pancreatic fistula (CR-POPF), Clavien-Dindo (C-D) ≥ III complications, overall perioperative morbidity, mortality, delayed gastric emptying (DGE), surgical site infections (SSIs), and conversion to open procedure were the evaluated outcome parameters.
RESULTS: Twelve comparative studies were included reporting a total of 21,586 patients with (n = 5475) and without (n = 16,111) obesity who underwent pancreatic resection. Obesity was associated with significantly higher rate of CR-POPF (OR:1.97; 95 % CI 1.60-2.43, p < 0.00001), CD ≥ III complications (OR:1.85; 95 % CI 1.50-2.27, p < 0.00001), overall perioperative morbidity (OR 1.69; 95 % CI 1.28-2.23, p = 0.0002), postoperative mortality (OR:1.45; 95 % CI 1.15-1.83, p = 0.002), DGE (OR:1.19; 95 % CI 1.09-1.29, p = 0.0001), and SSI (OR:1.70; 95 % CI 1.17-2.49, p = 0.006) when compared with no obesity. Where minimally invasive approaches were considered, no significant difference was found in conversion to open procedure (OR:0.59; 95 % CI 0.25-1.40, P = 0.23) between two groups. Sub-group analyses for type of pancreatectomy and surgical approach were consistent with the main analyses.
CONCLUSIONS: The meta-analysis of best possible evidence indicates that obesity is associated with increased morbidity and mortality following pancreatic resection and should be included in risk predication models for short-term outcomes after pancreatic resections. Impact of different sub-types of obesity on outcomes requires further research.
METHODS: A systematic search of electronic data sources and bibliographic reference lists were conducted. All studies reporting comparative outcomes of pancreatic resections in patients with versus without obesity (Body Mass Index (BMI)≥30 kg/m2) were included and their risk of bias were assessed. Clinically-relevant postoperative pancreatic fistula (CR-POPF), Clavien-Dindo (C-D) ≥ III complications, overall perioperative morbidity, mortality, delayed gastric emptying (DGE), surgical site infections (SSIs), and conversion to open procedure were the evaluated outcome parameters.
RESULTS: Twelve comparative studies were included reporting a total of 21,586 patients with (n = 5475) and without (n = 16,111) obesity who underwent pancreatic resection. Obesity was associated with significantly higher rate of CR-POPF (OR:1.97; 95 % CI 1.60-2.43, p < 0.00001), CD ≥ III complications (OR:1.85; 95 % CI 1.50-2.27, p < 0.00001), overall perioperative morbidity (OR 1.69; 95 % CI 1.28-2.23, p = 0.0002), postoperative mortality (OR:1.45; 95 % CI 1.15-1.83, p = 0.002), DGE (OR:1.19; 95 % CI 1.09-1.29, p = 0.0001), and SSI (OR:1.70; 95 % CI 1.17-2.49, p = 0.006) when compared with no obesity. Where minimally invasive approaches were considered, no significant difference was found in conversion to open procedure (OR:0.59; 95 % CI 0.25-1.40, P = 0.23) between two groups. Sub-group analyses for type of pancreatectomy and surgical approach were consistent with the main analyses.
CONCLUSIONS: The meta-analysis of best possible evidence indicates that obesity is associated with increased morbidity and mortality following pancreatic resection and should be included in risk predication models for short-term outcomes after pancreatic resections. Impact of different sub-types of obesity on outcomes requires further research.