Scholarlink

Objectives <p>This meta-analysis compares outcomes of pancreaticoduodenectomy (PD) using open (OPD), robotic (RPD), and laparoscopic (LPD) techniques in patients with and without obesity and resectable pancreatic cancer.</p> Methods <p>Thirteen observational studies evaluating 30-day mortality and postoperative complications in patients that underwent PD were included. Outcomes included mortality, major complications (Clavien-Dindo classification), and specific surgical complications: postoperative pancreatic fistula (POPF), post-PD hemorrhage (PPH), delayed gastric emptying (DGE), and surgical site infections (SSI).</p> Results <p>Patients with obesity had higher 30-day mortality rates (2.42% vs. 1.63%; OR: 1.68, 95% CI: 1.35–2.08, <i>p</i> &lt; 0.00001, I² = 0%) and major complications (23.3% vs. 17.12%; OR: 1.77, 95% CI: 1.27–2.46, <i>p</i> = 0.0007, I² = 52%) than patients without obesity. Obesity also increased the risk of POPF (21.9% vs. 13.76%; OR: 2.04, 95% CI: 1.69–2.46, <i>p</i> &lt; 0.00001, I² = 26%), PPH (7.31% vs. 6.26%; OR: 1.44, 95% CI: 1.07–1.94, <i>p</i> = 0.02, I² = 0%), and DGE (20.23% vs. 15.5%; OR: 1.98, 95% CI: 1.3–3.03, <i>p</i> &lt; 0.00001, I² = 89%). SSI risk trended higher in patients with obesity but was not statistically significant (28.17% vs. 20.39%; OR: 1.80, 95% CI: 0.93–3.5, <i>p</i> = 0.08, I² = 90%). Among surgical techniques, patients with obesity who underwent OPD had higher risks of 30-day mortality (OR: 1.59, 95% CI: 1.26–2.00, <i>p</i> &lt; .0001), major complications (OR 1.63, 95% CI 1.17–2.28, <i>p</i> = 0.004), and POPF (OR 1.98, 95% CI 1.59–2.47, <i>p</i> &lt; 0.00001) than patients without obesity. In the RPD group, obesity increased the risk of 30-day mortality (OR: 2.68, 95% CI: 1.12–6.39, <i>p</i> = 0.03) and POPF (OR 3.32, 95% CI 1.68–6.57, <i>p</i> = 0.0006). In LPD, obesity was associated with a higher risk of POPF (OR 2.06, 95%CI 1.69-3.32, <i>p</i> = 0.003).</p> Conclusions <p>Patients with obesity undergoing PD are at increased risk for 30-day mortality and major complications. OPD carries the highest overall risk, while RPD and LPD are linked to a greater POPF risk. These findings highlight the need for careful perioperative management in this high-risk population.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Mortality and complications in patients with obesity after open, robotic or laparoscopic pancreaticoduodenectomy: A systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年7月28日

查看全文
  • Juan Carlos Barrera Gutierrez,
  • Elaina Vivian,
  • Jimmy Shah,
  • Alejandro Mejia

摘要

Objectives

This meta-analysis compares outcomes of pancreaticoduodenectomy (PD) using open (OPD), robotic (RPD), and laparoscopic (LPD) techniques in patients with and without obesity and resectable pancreatic cancer.

Methods

Thirteen observational studies evaluating 30-day mortality and postoperative complications in patients that underwent PD were included. Outcomes included mortality, major complications (Clavien-Dindo classification), and specific surgical complications: postoperative pancreatic fistula (POPF), post-PD hemorrhage (PPH), delayed gastric emptying (DGE), and surgical site infections (SSI).

Results

Patients with obesity had higher 30-day mortality rates (2.42% vs. 1.63%; OR: 1.68, 95% CI: 1.35–2.08, p < 0.00001, I² = 0%) and major complications (23.3% vs. 17.12%; OR: 1.77, 95% CI: 1.27–2.46, p = 0.0007, I² = 52%) than patients without obesity. Obesity also increased the risk of POPF (21.9% vs. 13.76%; OR: 2.04, 95% CI: 1.69–2.46, p < 0.00001, I² = 26%), PPH (7.31% vs. 6.26%; OR: 1.44, 95% CI: 1.07–1.94, p = 0.02, I² = 0%), and DGE (20.23% vs. 15.5%; OR: 1.98, 95% CI: 1.3–3.03, p < 0.00001, I² = 89%). SSI risk trended higher in patients with obesity but was not statistically significant (28.17% vs. 20.39%; OR: 1.80, 95% CI: 0.93–3.5, p = 0.08, I² = 90%). Among surgical techniques, patients with obesity who underwent OPD had higher risks of 30-day mortality (OR: 1.59, 95% CI: 1.26–2.00, p < .0001), major complications (OR 1.63, 95% CI 1.17–2.28, p = 0.004), and POPF (OR 1.98, 95% CI 1.59–2.47, p < 0.00001) than patients without obesity. In the RPD group, obesity increased the risk of 30-day mortality (OR: 2.68, 95% CI: 1.12–6.39, p = 0.03) and POPF (OR 3.32, 95% CI 1.68–6.57, p = 0.0006). In LPD, obesity was associated with a higher risk of POPF (OR 2.06, 95%CI 1.69-3.32, p = 0.003).

Conclusions

Patients with obesity undergoing PD are at increased risk for 30-day mortality and major complications. OPD carries the highest overall risk, while RPD and LPD are linked to a greater POPF risk. These findings highlight the need for careful perioperative management in this high-risk population.