{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:13:14Z","timestamp":1789992794956,"version":"4.0.1"},"reference-count":99,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The majority of postoperative morbidity and mortality after partial pancreatectomy is attributable to postoperative pancreatic fistula. Several interventions to prevent postoperative pancreatic fistula have been assessed in randomized clinical trials but consensus on their efficacy is lacking. This is the first systematic review and meta-analysis of randomized trials focusing on strategies to prevent postoperative pancreatic fistula after all types of partial pancreatectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eligible randomized clinical trials assessing postoperative pancreatic fistula following partial pancreatectomy were included from the Evidence Map of Pancreatic Surgery database (2005\u20132025). As primary endpoint, both the 2005 and 2016 International Study Group for Pancreatic Surgery definitions of grade B\/C postoperative pancreatic fistula were accepted. Interventions shown to reduce postoperative pancreatic fistula in at least one randomized trial were identified, and meta-analysis undertaken for those with at least three available trials, irrespective of their outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 193 RCTs were included with 29 408 patients from 24 countries. The pooled rate of postoperative pancreatic fistula grade B\/C was 15.1%: 14.2% after pancreatoduodenectomy and 19.1% after left pancreatectomy. Overall, 24 trials identified 18 interventions as effective in reducing the rate of postoperative pancreatic fistula: 11 intraoperative and 7 postoperative. Eight interventions were eligible for meta-analysis, involving 46 trials. Following meta-analysis, three interventions remained effective: drain omission in left pancreatectomy, perioperative use of somatostatin analogues, and administration of perioperative corticosteroids. The certainty of evidence was high for drain omission, moderate for somatostatin analogues, and low for corticosteroids. Eleven trials focused specifically on high-risk patients and four on ongoing postoperative pancreatic fistula. No trial combined interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Omission of drains in left pancreatectomy, perioperative use of somatostatin analogues, and administration of perioperative corticosteroids are effective strategies to prevent postoperative pancreatic fistula after partial pancreatectomy. However, current evidence remains immature and further RCTs evaluating these interventions are warranted, as they are likely to change the conclusions of subsequent meta-analyses. Such trials could potentially focus on high-risk patient cohorts and\/or assess combinations of interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag088","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:50:03Z","timestamp":1780487403000},"source":"Crossref","is-referenced-by-count":0,"title":["Preventing pancreatic fistula following pancreatectomy: meta-analysis of randomized clinical trials"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6260-2269","authenticated-orcid":false,"given":"Roberto M","family":"Montorsi","sequence":"first","affiliation":[{"name":"Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust , Verona ,","place":["Italy"]},{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3365-7713","authenticated-orcid":false,"given":"Alessio","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust , Verona ,","place":["Italy"]},{"name":"Department of Surgery, NewYork University Grossman School of Medicine , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7418-3056","authenticated-orcid":false,"given":"Tessa E","family":"Hendriks","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Department of Surgery, Leiden University Medical Center , Leiden ,","place":["the Netherlands"]},{"name":"Dutch Institute for Clinical Auditing , Leiden ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freek","family":"Daams","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Department of Surgery, Amsterdam UMC, Location Vrije Universiteit , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9605-6831","authenticated-orcid":false,"given":"Olivier R","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1917-6973","authenticated-orcid":false,"given":"Bas","family":"Groot Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5244-4357","authenticated-orcid":false,"given":"Matteo","family":"De Pastena","sequence":"additional","affiliation":[{"name":"Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hjalmar C","family":"van Santvoort","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht\/St Antonius Hospital Nieuwegein , Utrecht ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert A","family":"Bonsing","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden University Medical Center , Leiden ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Paiella","sequence":"additional","affiliation":[{"name":"Pancreatic Surgery Unit, Department of Engineering for Innovation Medicine (DIMI), University of Verona , Verona ,","place":["Italy"]},{"name":"Pancreatic Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-2628","authenticated-orcid":false,"given":"Giuseppe","family":"Malleo","sequence":"additional","affiliation":[{"name":"Pancreatic Surgery Unit, Department of Engineering for Innovation Medicine (DIMI), University of Verona , Verona ,","place":["Italy"]},{"name":"Pancreatic Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2650-9350","authenticated-orcid":false,"given":"Marc G","family":"Besselink","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Salvia","sequence":"additional","affiliation":[{"name":"Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust , Verona ,","place":["Italy"]},{"name":"Pancreatic Surgery Unit, Department of Engineering for Innovation Medicine (DIMI), University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026092106254841800_zrag088-B1","article-title":"Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries","volume":"111","year":"2024","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.surg.2013.05.035","article-title":"Use and results of consensus definitions in pancreatic surgery: a systematic review","volume":"155","author":"Harnoss","year":"2014","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.surg.2005.05.001","article-title":"Postoperative pancreatic fistula: an international study group (ISGPF) definition","volume":"138","author":"Bassi","year":"2005","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B4","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B5","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/2046-4053-1-2","article-title":"The nuts and bolts of PROSPERO: an international prospective register of systematic reviews","volume":"1","author":"Booth","year":"2012","journal-title":"Syst Rev"},{"key":"2026092106254841800_zrag088-B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"2026092106254841800_zrag088-B7","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int J Surg"},{"key":"2026092106254841800_zrag088-B8","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.surg.2021.04.023","article-title":"Evidence map of pancreatic surgery\u2014a living systematic review with meta-analyses by the International Study Group of Pancreatic Surgery (ISGPS)","volume":"170","author":"Probst","year":"2021","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jamcollsurg.2012.09.002","article-title":"A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy","volume":"216","author":"Callery","year":"2013","journal-title":"J Am Coll Surg"},{"key":"2026092106254841800_zrag088-B10","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/SLA.0000000000002620","article-title":"Alternative fistula risk score for pancreatoduodenectomy (a-FRS): design and international external validation","volume":"269","author":"Mungroop","year":"2019","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B11","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.surg.2007.05.005","article-title":"Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.surg.2007.02.001","article-title":"Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B13","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2026092106254841800_zrag088-B14","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"2026092106254841800_zrag088-B15","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3102\/1076998609346961","article-title":"How many studies do you need?: a primer on statistical power for meta-analysis","volume":"35","author":"Valentine","year":"2010","journal-title":"J Educ Behav Stat"},{"key":"2026092106254841800_zrag088-B16","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.ED000142","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092106254841800_zrag088-B17","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.pan.2019.05.457","article-title":"Perioperative hydrocortisone treatment reduces postoperative pancreatic fistula rate after open distal pancreatectomy. A randomized placebo-controlled trial","volume":"19","author":"Antila","year":"2019","journal-title":"Pancreatology"},{"key":"2026092106254841800_zrag088-B18","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1016\/S0140-6736(22)00182-9","article-title":"Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: an open-label, nationwide, stepped-wedge cluster-randomised trial","volume":"399","author":"Smits","year":"2022","journal-title":"Lancet"},{"key":"2026092106254841800_zrag088-B19","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1002\/bjs.8654","article-title":"Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy","volume":"99","author":"Motoi","year":"2012","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B20","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/bjs.10727","article-title":"Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy","volume":"105","author":"Senda","year":"2018","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B21","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jamcollsurg.2015.10.003","article-title":"Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy: a prospective, randomized controlled trial from a single surgeon","volume":"222","author":"Bai","year":"2016","journal-title":"J Am Coll Surg"},{"key":"2026092106254841800_zrag088-B22","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.surg.2015.04.020","article-title":"Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial","volume":"158","author":"Xu","year":"2015","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B23","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.jamcollsurg.2008.12.031","article-title":"Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial","volume":"208","author":"Berger","year":"2009","journal-title":"J Am Coll Surg"},{"key":"2026092106254841800_zrag088-B24","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1245\/s10434-020-09204-z","article-title":"Novel technique for single-layer pancreatojejunostomy is not inferior to modified Blumgart anastomosis in robotic pancreatoduodenectomy: results of a randomized controlled trial","volume":"28","author":"Liu","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"2026092106254841800_zrag088-B25","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1007\/s11605-018-4059-4","article-title":"A new feasible technique for polytetrafluoroethylene suture buttress-reinforced pancreaticojejunostomy (PBRP): mechanical analysis and a prospective, randomized controlled trial","volume":"23","author":"Shao","year":"2019","journal-title":"J Gastrointest Surg"},{"key":"2026092106254841800_zrag088-B26","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrad028","article-title":"Polyethylene glycol-coated haemostatic patch for prevention of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: randomized clinical trial","volume":"7","author":"Serradilla-Mart\u00edn","year":"2023","journal-title":"BJS Open"},{"key":"2026092106254841800_zrag088-B27","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1002\/bjs.9252","article-title":"Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy","volume":"100","author":"Figueras","year":"2013","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B28","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S1470-2045(13)70126-8","article-title":"Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial","volume":"14","author":"Topal","year":"2013","journal-title":"Lancet Oncol"},{"key":"2026092106254841800_zrag088-B29","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s00595-013-0522-8","article-title":"Is the enteral replacement of externally drained pancreatic juice valuable after pancreatoduodenectomy?","volume":"44","author":"Yokoyama","year":"2014","journal-title":"Surg Today"},{"key":"2026092106254841800_zrag088-B30","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S2468-1253(24)00037-2","article-title":"Prophylactic abdominal drainage after distal pancreatectomy (PANDORINA): an international, multicentre, open-label, randomised controlled, non-inferiority trial","volume":"9","author":"van Bodegraven","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026092106254841800_zrag088-B31","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1097\/SLA.0000000000001859","article-title":"No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707)","volume":"264","author":"Witzigmann","year":"2016","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B32","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1097\/SLA.0000000000004992","article-title":"Early drain removal is safe in patients with low or intermediate risk of pancreatic fistula after pancreaticoduodenectomy: a multicenter, randomized controlled trial","volume":"275","author":"Dai","year":"2022","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B33","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1001\/jama.2023.5728","article-title":"Piperacillin\u2013tazobactam compared with cefoxitin as antimicrobial prophylaxis for pancreatoduodenectomy: a randomized clinical trial","volume":"329","author":"D\u2019Angelica","year":"2023","journal-title":"JAMA"},{"key":"2026092106254841800_zrag088-B34","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1002\/ags3.12209","article-title":"Dual-center randomized clinical trial exploring the optimal duration of antimicrobial prophylaxis in patients undergoing pancreaticoduodenectomy following biliary drainage","volume":"2","author":"Yamamoto","year":"2018","journal-title":"Ann Gastroenterol Surg"},{"key":"2026092106254841800_zrag088-B35","article-title":"Preventive effects of ulinastatin on complications related to pancreaticoduodenectomy: a consort-prospective, randomized, double-blind, placebo-controlled trial","volume":"95","author":"Zhang","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"2026092106254841800_zrag088-B36","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1007\/s00535-021-01818-8","article-title":"A randomised, multicentre trial of somatostatin to prevent clinically relevant postoperative pancreatic fistula in intermediate-risk patients after pancreaticoduodenectomy","volume":"56","author":"Cao","year":"2021","journal-title":"J Gastroenterol"},{"key":"2026092106254841800_zrag088-B37","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1056\/NEJMoa1313688","article-title":"Pasireotide for postoperative pancreatic fistula","volume":"370","author":"Allen","year":"2014","journal-title":"N Engl J Med"},{"key":"2026092106254841800_zrag088-B38","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/SLA.0000000000001896","article-title":"Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC)","volume":"264","author":"Perinel","year":"2016","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B39","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9103085","article-title":"Effect of flowable thrombin-containing collagen-based hemostatic matrix for preventing pancreatic fistula after pancreatectomy: a randomized clinical trial","volume":"9","author":"Park","year":"2020","journal-title":"J Clin Med"},{"key":"2026092106254841800_zrag088-B40","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1001\/jamasurg.2016.3644","article-title":"Effect of polyglycolic acid mesh for prevention of pancreatic fistula following distal pancreatectomy: a randomized clinical trial","volume":"152","author":"Jang","year":"2017","journal-title":"JAMA Surg"},{"key":"2026092106254841800_zrag088-B41","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1097\/SLA.0b013e31825659ef","article-title":"Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial","volume":"255","author":"Hamilton","year":"2012","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B42","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00423-023-02873-w","article-title":"A randomized controlled trial evaluating effects of prophylactic irrigation-suction near pancreaticojejunostomy on postoperative pancreatic fistula after pancreaticoduodenectomy","volume":"408","author":"Lin","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"2026092106254841800_zrag088-B43","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrab001","article-title":"Randomized clinical trial and meta-analysis of the impact of a fibrin sealant patch on pancreatic fistula after distal pancreatectomy: CPR trial","volume":"5","author":"Mungroop","year":"2021","journal-title":"BJS Open"},{"key":"2026092106254841800_zrag088-B44","doi-asserted-by":"crossref","first-page":"4033","DOI":"10.1007\/s00464-021-08724-3","article-title":"A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy","volume":"36","author":"Landoni","year":"2022","journal-title":"Surg Endosc"},{"key":"2026092106254841800_zrag088-B45","first-page":"469","article-title":"End-to-side duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. A comparison trial of small versus larger jejunal incision. A single center experience","volume":"91","author":"di Mola","year":"2020","journal-title":"Ann Ital Chir"},{"key":"2026092106254841800_zrag088-B46","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1007\/s00268-019-05172-y","article-title":"The effect of fibrinogen\/thrombin-coated collagen patch (TachoSil\u00ae) application in pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: a randomized clinical trial","volume":"43","author":"Kwon","year":"2019","journal-title":"World J Surg"},{"key":"2026092106254841800_zrag088-B47","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/jso.24873","article-title":"Pancreaticojejunostomy: does the technique matter? A randomized trial","volume":"117","author":"Singh","year":"2018","journal-title":"J Surg Oncol"},{"key":"2026092106254841800_zrag088-B48","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1002\/bjs.10840","article-title":"Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy","volume":"105","author":"Schindl","year":"2018","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B49","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.surg.2018.05.030","article-title":"Results of a randomized controlled trial comparing closed-suction drains versus passive gravity drains after pancreatic resection","volume":"164","author":"\u010ce\u010dka","year":"2018","journal-title":"Surgery"},{"key":"2026092106254841800_zrag088-B50","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1007\/s00464-016-5046-z","article-title":"Robot-assisted laparoscopic versus open middle pancreatectomy: short-term results of a randomized controlled trial","volume":"31","author":"Chen","year":"2017","journal-title":"Surg Endosc"},{"key":"2026092106254841800_zrag088-B51","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/bjs.10160","article-title":"Randomized multicentre trial comparing external and internal pancreatic stenting during pancreaticoduodenectomy","volume":"103","author":"Jang","year":"2016","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B52","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/SLA.0000000000001240","article-title":"Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial","volume":"263","author":"Keck","year":"2016","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B53","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/SLA.0000000000001913","article-title":"Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial)","volume":"264","author":"Hassenpflug","year":"2016","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B54","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1503\/cjs.010014","article-title":"In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy","volume":"58","author":"Grendar","year":"2015","journal-title":"Can J Surg"},{"key":"2026092106254841800_zrag088-B55","doi-asserted-by":"crossref","first-page":"3905","DOI":"10.1245\/s10434-015-4496-1","article-title":"Influence of food intake on the healing process of postoperative pancreatic fistula after pancreatoduodenectomy: a multi-institutional randomized controlled trial","volume":"22","author":"Fujii","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"2026092106254841800_zrag088-B56","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1111\/hpb.12018","article-title":"Does fibrin glue sealant decrease the rate of anastomotic leak after a pancreaticoduodenectomy? Results of a prospective randomized trial","volume":"15","author":"Martin","year":"2013","journal-title":"HPB (Oxford)"},{"key":"2026092106254841800_zrag088-B57","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/SLA.0b013e318272dec0","article-title":"Efficacy of an absorbable fibrin sealant patch (TachoSil) after distal pancreatectomy: a multicenter, randomized, controlled trial","volume":"256","author":"Montorsi","year":"2012","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B58","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/SLA.0b013e3181e61e88","article-title":"Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial","volume":"252","author":"Bassi","year":"2010","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B59","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1097\/SLA.0b013e3181492c28","article-title":"External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial","volume":"246","author":"Poon","year":"2007","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B60","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.gassur.2006.07.020","article-title":"Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial","volume":"10","author":"Winter","year":"2006","journal-title":"J Gastrointest Surg"},{"key":"2026092106254841800_zrag088-B61","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S2468-1253(19)30004-4","article-title":"Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2\/3 trial","volume":"4","author":"van Hilst","year":"2019","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026092106254841800_zrag088-B62","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s00423-018-1736-4","article-title":"Effect of early administration of coagulation factor XIII on fistula after pancreatic surgery: the FIPS randomized controlled trial","volume":"403","author":"Takeda","year":"2018","journal-title":"Langenbecks Arch Surg"},{"key":"2026092106254841800_zrag088-B63","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/bjs.11087","article-title":"Randomized trial of oral versus enteral feeding for patients with postoperative pancreatic fistula after pancreatoduodenectomy","volume":"106","author":"Wu","year":"2019","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B64","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000002398","article-title":"Oral food intake versus fasting on postoperative pancreatic fistula after distal pancreatectomy: a multi-institutional randomized controlled trial","volume":"94","author":"Fujii","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"2026092106254841800_zrag088-B65","doi-asserted-by":"crossref","first-page":"3629","DOI":"10.1007\/s00464-021-08909-w","article-title":"Pancreaticojejunostomy without pancreatic duct stent after laparoscopic pancreatoduodenectomy: preliminary outcomes from a prospective randomized controlled trial","volume":"36","author":"Cai","year":"2022","journal-title":"Surg Endosc"},{"key":"2026092106254841800_zrag088-B66","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5604\/01.3001.0014.7225","article-title":"Internal stenting across the pancreaticojejunostomy and main pancreatic duct after pancreaticoduodenectomy","volume":"93","author":"Singh","year":"2021","journal-title":"Pol Przegl Chir"},{"key":"2026092106254841800_zrag088-B67","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/0300060517717400","article-title":"Comparison of patient outcomes with and without stenting tube in pancreaticoduodenectomy","volume":"46","author":"Bin","year":"2018","journal-title":"J Int Med Res"},{"key":"2026092106254841800_zrag088-B68","first-page":"348","article-title":"Stented pancreatico-duodenectomy: does it lead to decreased pancreatic fistula rates? A prospective randomized study","volume":"68","author":"Qureshi","year":"2018","journal-title":"J Pak Med Assoc"},{"key":"2026092106254841800_zrag088-B69","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/MPA.0b013e3181e861fa","article-title":"Stenting versus non-stenting in pancreaticojejunostomy: a prospective study limited to a normal pancreas without fibrosis sorted by using dynamic MRI","volume":"40","author":"Kuroki","year":"2011","journal-title":"Pancreas"},{"key":"2026092106254841800_zrag088-B70","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1097\/SLA.0b013e31821219af","article-title":"External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial","volume":"253","author":"Pessaux","year":"2011","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B71","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijsu.2015.02.002","article-title":"Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study","volume":"16","author":"El Nakeeb","year":"2015","journal-title":"Int J Surg"},{"key":"2026092106254841800_zrag088-B72","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1097\/SLA.0b013e31818fefc7","article-title":"Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study","volume":"248","author":"Fern\u00e1ndez-Cruz","year":"2008","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B73","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1001\/jamasurg.2019.6035","article-title":"Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3, randomized clinical trial","volume":"155","author":"Andrianello","year":"2020","journal-title":"JAMA Surg"},{"key":"2026092106254841800_zrag088-B74","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00423-020-01982-0","article-title":"Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy regarding incidence of delayed gastric emptying after pancreaticoduodenectomy","volume":"405","author":"Eguchi","year":"2020","journal-title":"Langenbecks Arch Surg"},{"key":"2026092106254841800_zrag088-B75","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1007\/s11605-012-1940-4","article-title":"Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy","volume":"16","author":"Wellner","year":"2012","journal-title":"J Gastrointest Surg"},{"key":"2026092106254841800_zrag088-B76","doi-asserted-by":"crossref","first-page":"e033","DOI":"10.1097\/AS9.0000000000000033","article-title":"Clinical impact of stump closure reinforced with Hemopatch on the prevention of clinically relevant pancreatic fistula after distal pancreatectomy: a multicenter randomized trial","volume":"2","author":"Uranues","year":"2021","journal-title":"Ann Surg Open"},{"key":"2026092106254841800_zrag088-B77","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.amjsurg.2015.04.015","article-title":"Stump closure reinforcement with absorbable fibrin collagen sealant sponge (TachoSil) does not prevent pancreatic fistula after distal pancreatectomy: the FIABLE multicenter controlled randomized study","volume":"210","author":"Sa Cunha","year":"2015","journal-title":"Am J Surg"},{"key":"2026092106254841800_zrag088-B78","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s11605-012-1963-x","article-title":"A dual-institution randomized controlled trial of remnant closure after distal pancreatectomy: does the addition of a falciform patch and fibrin glue improve outcomes?","volume":"17","author":"Carter","year":"2013","journal-title":"J Gastrointest Surg"},{"key":"2026092106254841800_zrag088-B79","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/JP9.0000000000000049","article-title":"Early drain removal after major pancreatectomy reduces postoperative complications: a single-center, randomized, controlled trial","volume":"3","author":"Dai","year":"2020","journal-title":"J Pancreatol"},{"key":"2026092106254841800_zrag088-B80","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jviscsurg.2018.06.006","article-title":"Early removal of intraperitoneal drainage after pancreatoduodenectomy in patients without postoperative fistula at POD3: results of a randomized clinical trial","volume":"156","author":"Dembinski","year":"2019","journal-title":"J Visc Surg"},{"key":"2026092106254841800_zrag088-B81","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/SLA.0000000000006651","article-title":"Reconsidering abdominal drainage after left pancreatectomy: the randomized controlled PANDRA II trial","volume":"282","author":"Kaiser","year":"2025","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B82","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/SLA.0000000000002375","article-title":"A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage","volume":"266","author":"Van Buren","year":"2017","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B83","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.asjsur.2018.08.006","article-title":"Randomized controlled study of the effect of octreotide on pancreatic exocrine secretion and pancreatic fistula after pancreatoduodenectomy","volume":"42","author":"You","year":"2019","journal-title":"Asian J Surg"},{"key":"2026092106254841800_zrag088-B84","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.hbpd.2018.01.015","article-title":"Efficacy of octreotide in the prevention of complications after pancreaticoduodenectomy in patients with soft pancreas and non-dilated pancreatic duct: a prospective randomized trial","volume":"17","author":"El Nakeeb","year":"2018","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"2026092106254841800_zrag088-B85","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1007\/s11605-015-2925-x","article-title":"Octreotide does not prevent pancreatic fistula following pancreatoduodenectomy in patients with soft pancreas and non-dilated duct: a prospective randomized controlled trial","volume":"19","author":"Kurumboor","year":"2015","journal-title":"J Gastrointest Surg"},{"key":"2026092106254841800_zrag088-B86","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1477-2574.2012.00608.x","article-title":"Prospective randomized trial of the effect of octreotide on pancreatic juice output after pancreaticoduodenectomy in relation to histological diagnosis, duct size and leakage","volume":"15","author":"Fern\u00e1ndez-Cruz","year":"2013","journal-title":"HPB (Oxford)"},{"key":"2026092106254841800_zrag088-B87","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/SLA.0000000000006240","article-title":"The effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy: a multicenter randomized controlled trial","volume":"280","author":"Chen","year":"2024","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B88","doi-asserted-by":"crossref","first-page":"350","DOI":"10.14701\/ahbps.24-021","article-title":"Does perioperative hydrocortisone or indomethacin improve pancreatoduodenectomy outcomes? A triple arm, randomized placebo-controlled trial","volume":"28","author":"Kant","year":"2024","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"key":"2026092106254841800_zrag088-B89","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1097\/SLA.0000000000001883","article-title":"Perioperative hydrocortisone reduces major complications after pancreaticoduodenectomy: a randomized controlled trial","volume":"264","author":"Laaninen","year":"2016","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B90","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1093\/bjs\/znac074","article-title":"Perioperative interventions to reduce pancreatic fistula following pancreatoduodenectomy: meta-analysis","volume":"109","author":"PARANOIA Study Group","year":"2022","journal-title":"Br J Surg"},{"key":"2026092106254841800_zrag088-B91","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1097\/SLA.0000000000006564","article-title":"Comparative assessment of outcomes: abdominal drain versus no abdominal drain after left pancreatectomy\u2014a systematic review and meta-analysis","volume":"281","author":"Fatima","year":"2025","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B92","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12051750","article-title":"Perioperative drug treatment in pancreatic surgery\u2014a systematic review and meta-analysis","volume":"12","author":"Rompen","year":"2023","journal-title":"J Clin Med"},{"key":"2026092106254841800_zrag088-B93","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/SLA.0000000000006313","article-title":"Somatostatin versus octreotide for prevention of postoperative pancreatic fistula: the PREFIPS randomized clinical trial: a FRENCH 007-ACHBT study","volume":"280","author":"Gaujoux","year":"2024","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B94","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s11605-019-04479-4","article-title":"Efficacy of pasireotide for prevention of postoperative pancreatic fistula in pancreatic surgery: a systematic review and meta-analysis","volume":"24","author":"Liu","year":"2020","journal-title":"J Gastrointest Surg"},{"key":"2026092106254841800_zrag088-B95","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/SLA.0000000000001892","article-title":"The cost of postoperative pancreatic fistula versus the cost of pasireotide: results from a prospective randomized trial","volume":"265","author":"Ma","year":"2017","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B96","doi-asserted-by":"crossref","first-page":"e94","DOI":"10.1097\/SLA.0000000000002225","article-title":"Pasireotide for the prevention of postoperative pancreatic fistula: time to curb the enthusiasm?","volume":"267","author":"Maggino","year":"2018","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B97","doi-asserted-by":"crossref","first-page":"2841","DOI":"10.1245\/s10434-024-16704-9","article-title":"The effects of perioperative corticosteroids on postoperative complications after pancreatoduodenectomy: a debated topic of systematic review and meta-analysis","volume":"32","author":"Liu","year":"2025","journal-title":"Ann Surg Oncol"},{"key":"2026092106254841800_zrag088-B98","doi-asserted-by":"crossref","first-page":"e597","DOI":"10.1097\/SLA.0000000000004855","article-title":"A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the International Study Group of Pancreatic Surgery","volume":"277","author":"Schuh","year":"2023","journal-title":"Ann Surg"},{"key":"2026092106254841800_zrag088-B99","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1053\/j.gastro.2011.03.040","article-title":"Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial","volume":"141","author":"Klek","year":"2011","journal-title":"Gastroenterology"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag088\/71276276\/zrag088.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag088\/71276276\/zrag088.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:39:16Z","timestamp":1789990756000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag088\/8823616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":99,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag088","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,4]]},"article-number":"zrag088"}}