Evidence map›Paper›PMID 38814751›Full record

SynthesisBJS open2024

Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials.

Jonas K Walber, Pia Antony, Hendrik Strothmann, Eva Kalkum, Pietro Renzulli, Fabian Hauswirth, Pascal Probst, Markus K Muller

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in BJS open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Jonas K WalberDepartment of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Pia AntonyDepartment of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Hendrik StrothmannDepartment of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Eva KalkumStudy Centre of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany.
Pietro RenzulliDepartment of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Fabian HauswirthDepartment of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Pascal ProbstDepartment of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland.
Markus K MullerDepartment of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative pancreatic fistulas remain a driver of major complications after partial pancreatectomy. It is unclear whether coverage of the anastomosis or pancreatic remnant can reduce the incidence of postoperative pancreatic fistulas. The aim of this study was to evaluate the effect of autologous or artificial coverage of the pancreatic remnant or anastomosis on outcomes after partial pancreatectomy.

methodsA systematic literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to March 2024. All RCTs analysing a coverage method in patients undergoing partial pancreatoduodenectomy or distal pancreatectomy were included. The primary outcome was postoperative pancreatic fistula development. Subgroup analyses for pancreatoduodenectomy or distal pancreatectomy and artificial or autologous coverage were conducted.

resultsA total of 18 RCTs with 2326 patients were included. In the overall analysis, coverage decreased the incidence of postoperative pancreatic fistulas by 29% (OR 0.71, 95% c.i. 0.54 to 0.93, P < 0.01). This decrease was also seen in the 12 RCTs covering the remnant after distal pancreatectomy (OR 0.69, 95% c.i. 0.51 to 0.94, P < 0.02) and the 4 RCTs applying autologous coverage after pancreatoduodenectomy and distal pancreatectomy (OR 0.53, 95% c.i. 0.29 to 0.96, P < 0.04). Other subgroup analyses (artificial coverage or pancreatoduodenectomy) showed no statistically significant differences. The secondary endpoints of mortality, reoperations, and re-interventions were each affected positively by the use of coverage techniques. The certainty of evidence was very low to moderate.

conclusionThe implementation of coverage, whether artificial or autologous, is beneficial after partial pancreatectomy, especially in patients undergoing distal pancreatectomy with autologous coverage.

Indexed as

Anastomosis, SurgicalPancreatectomyPancreatic FistulaPancreaticoduodenectomyPostoperative ComplicationsRandomized Controlled Trials as TopicHumansPancreas

Identifiers

PMID38814751
PMCPMC11138960

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.