Abstract Background Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy. Methods This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005–2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines. Results From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P = 0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24 h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P = 0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel–Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84). Conclusion Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.

中文翻译：

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胰十二指肠切除术后胰瘘再次剖腹术中完成胰腺切除术或保留胰腺手术：多中心队列研究和荟萃分析

摘要 背景尽管初次经皮导管引流已成为标准做法，但一些胰十二指肠切除术后出现胰瘘的患者最终仍需接受再次剖腹手术。本研究的目的是比较胰十二指肠切除术后因胰瘘再次剖腹手术的患者的完整胰腺切除术和保留胰腺手术。 方法这项回顾性队列研究纳入了九家机构，纳入了 2005 年至 2018 年胰十二指肠切除术后因胰瘘再次接受剖腹手术的患者。此外，根据 PRISMA 指南进行了系统评价和荟萃分析。 结果在 4877 名接受胰十二指肠切除术的患者中，786 名（16%）出现 B/C 级胰瘘，162 名（3%）因胰瘘接受了再次剖腹手术。在这些患者中，36 名（22%）接受了完整胰腺切除术，126 名（78%）接受了胰腺保留手术。完成胰腺切除术后死亡率较高（20 名患者（56%）对比 40 名患者（32%）；P = 0.009），在调整性别、年龄、BMI、ASA 评分、既往再次干预和器官衰竭后，24 名患者的死亡率仍然较高。再次剖腹手术前 h（调整后优势比 2.55，95% CI 1.07 至 6.08）。组间额外再干预的比例没有差异（23 名患者（64%）与 84 名患者（67%）相比；P = 0.756）。这项荟萃分析包括评估 745 名患者的 33 项研究，证实了完全胰腺切除术与死亡率之间的关联（Mantel-Haenszel 随机效应模型：比值比 1.99，95% CI 1.03 至 3.84）。 结论根据目前的数据，对于胰十二指肠切除术后因胰瘘而需要再次剖腹手术的患者，保留胰腺手术似乎优于完成胰腺切除术。