Impact of neoadjuvant chemoradiotherapy on postoperative clinically significant pancreatic fistula. A systemic review and updated meta-analysis.
Bibliographic record
Abstract
Background: Pancreatic fistula is one of the main complications after pancreatic surgery and the leading cause of morbidity and mortality after pancreatic surgery. There are many pieces of evidence emerging out from retrospective studies and metanalysis that neoadjuvant chemoradiation decreases rates of clinically significant postoperative pancreatic fistula. Aims and objectives: The primary aim of our analysis was to do a systemic review and updated meta-analysis of literature published in the last 10 years and look for the association of neoadjuvant chemoradiation and risk of subsequent clinically significant pancreatic fistula. Methods: EMBASE, MEDLINE, and the Cochrane Database were searched for Studies comparing outcomes in patients receiving neoadjuvant chemoradiotherapy first with those patients who received surgery first in case of pancreatic cancer. A systemic review and Metanalysis were done according to MOOSE and PRISMA guidelines. Heterogeneity was measured using Q tests and I2, and p < 0.10 was determined as significant. The Odds ratios (OR) and Risk Ratios (RR) were calculated for dichotomous data as per the requirement, and weighted mean differences (WMD) were used for continuous variables. Nonrandomized trials were accessed for bias using the New Castle Ottawa scale. Publication bias was studied using funnel plots. The meta-analysis was conducted using Open Review Manager 5.4. Results: Twenty-six studies including 17021 patients finally included in the analysis. 339 patients out of a total of 3386 developed clinically significant pancreatic fistula in the neoadjuvant first group. 2342 patients out of 13335 patients developed clinically significant pancreatic fistula in the surgery first group. Neoadjuvant treatment significantly reduced the risk of subsequent clinically significant pancreatic fistula. (p= <0.0001). The number of patients with soft pancreas was significantly higher in the surgery first group. (p <0.0001). Pancreatic duct diameter mentioned in only two studies but there was no significant difference between both groups. [p=1].Blood loss was significantly more in the surgery first group.[ p <0.0001]. There was no difference in pancreaticoduodenectomy or distal pancreatectomy performed between both groups. (p=0.82). There was no difference in the number of borderline resectable pancreatic tumors between both groups. (p= 0.34). There was no difference in overall grade 3/grade 4 complications rate between both groups. (p= 0.39). Conclusion: Neoadjuvant treatments may be responsible for the lower rates of clinically significant pancreatic fistula after subsequent surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.037 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".