Evidence map›Paper›PMID 42273573›Full record

ArticleHepatobiliary surgery and nutrition2026

Does neoadjuvant therapy reduce pancreatic fistula after pancreatoduodenectomy and distal pancreatectomy?-a systematic review and meta-analysis.

Sandro Hügli, Victor Lopez-Lopez, Sarvar Abdurakhmonov, Jan Philipp Jonas, Elena Rangelova, Luana Genova, Giuseppe Malleo, Ryan K Schmocker, Lea Timmermann, Thomas Malinka and 23 more

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Article in Hepatobiliary surgery and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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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

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4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

33 authors.

Sandro Hügli *Department of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Victor Lopez-Lopez *Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
Sarvar AbdurakhmonovClinic for Surgery, Department of Internal Diseases, Faculty of Medicine, Karshi State University, Karshi, Uzbekistan.
Jan Philipp JonasDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Elena RangelovaDepartment of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Luana GenovaDepartment of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Giuseppe MalleoUnit of General and Pancreatic Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
Ryan K SchmockerDepartment of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
Lea TimmermannDepartment of Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Thomas MalinkaDepartment of Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Scott HeltonSection of General, Thoracic and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Ralph FritschDepartment of Hematology and Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Fabian KaltDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Carol Ann TrachselDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Fabian RösslerDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
John BryantDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Russel PalmThe Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Sarah E HoffeDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Cristiano GuidettiHepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
Fabrizio Di BenedettoHepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
Daniel PietraszDepartment of Hepatogastroenterology and Gastrointestinal Oncology, Hôpital Européen Georges-Pompidou, AGEO (Association des Gastro-Enterologues Oncologues), Université de Paris, SIRIC CARPEM, Paris, France.
Sameer H PatelDivision of Surgical Oncology, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Gregory C WilsonDivision of Surgical Oncology, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Syed A AhmadDivision of Surgical Oncology, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Jin HeThe Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Changhoon YooDepartment of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Julien TaiebDepartment of Hepatogastroenterology and Gastrointestinal Oncology, Hôpital Européen Georges-Pompidou, AGEO (Association des Gastro-Enterologues Oncologues), Université de Paris, SIRIC CARPEM, Paris, France.
Henrik PetrowskyDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Juan LujanDepartment of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
Ricardo Robles-CamposDepartment of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
Ernesto SparrelidDivision of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Jose OberholzerDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Dilmurodjon EshmuminovDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Postoperative pancreatic fistula (POPF) is a major complication after pancreatic resection. This systematic review and meta-analysis investigated the impact of neoadjuvant therapy (NAT) on POPF rates after pancreatoduodenectomy (Whipple procedure) and distal pancreatectomy. Methods: A systematic search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Central Register of Controlled Trials was conducted for studies published since 2016 using the updated International Study Group of Pancreatic Fistula (ISGPF) definition for POPF. Random-effects models were used to pool data. Results: Thirty studies (22,048 patients) were included. Of those, 24 were comparative studies between neoadjuvant and upfront surgery (UPS) groups, while 6 reported POPF rates only in the neoadjuvant group. NAT significantly reduced POPF rates after Whipple procedure [risk ratio (RR) 0.44, 95% confidence intervals (CI): 0.38-0.52, P<0.01]. A harder pancreatic texture was more common after NAT compared to UPS (RR 1.27, 95% CI: 1.23-1.32, P<0.001). There were no significant differences between the neoadjuvant and upfront surgery groups regarding pancreatic duct size or body mass index (BMI). Conclusions: NAT reduces POPF after Whipple procedure, likely by altering pancreatic texture. The exact mechanisms by which the pancreas becomes harder during neoadjuvant treatment remain unclear. This finding could be implemented to improve surgical outcomes in patients with a soft pancreas. However, accurately predicting tumor response to NAT is a prerequisite for such an approach to avoid potential disease progression. Advances in personalized medicine, where tumor response could be predicted, offer hope for tailoring treatment strategies and maximizing outcomes.

Indexed as

distal pancreatectomyneoadjuvant treatmentpancreatoduodenectomyPostoperative pancreatic fistula (POPF)

Identifiers

PMID42273573
PMCPMC13247779

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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 OpenQuestion graph.