Predictors of post-operative pancreatic fistula after pancreaticoduodenectomy: systematic review and meta-analysis protocol

Abstract Pancreaticoduodenectomy is the standard treatment for resectable pancreatic head and periampullary cancers. Despite advancements, post-operative pancreatic fistula (POPF) remains a significant complication. The pathophysiology of POPF is multifactorial, involving patient-related factors, surgical technique, and postoperative management. Identifying reliable predictors for POPF is crucial for risk stratification and improving patient outcomes. This study aims to systematically review the literature and perform a meta-analysis to identify the most consistent and significant predictors of POPF following pancreaticoduodenectomy. The objectives are to evaluate preoperative, intraoperative, and postoperative factors and determine their relative importance and strength of association with POPF. This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered with PROSPERO. The systematic review and meta-analysis will also follow the Population, Intervention, Comparators and Outcomes framework. A comprehensive literature search will be conducted across PUBMED, SCOPUS, and the Cochrane Library. Studies will be selected based on inclusion criteria, and data will be extracted and assessed for quality using standardized tools. Meta-analysis will be performed using a random-effects model, and the confidence in cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.