title: Preoperative diabetes as a protective factor for pancreatic fistula after pancreaticoduodenectomy: a meta-analysis.
abstract: BACKGROUND
  The role of diabetes mellitus (DM) in pancreatic fistula (PF) or clinical relevant PF (CR-PF) after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD) is unclear. We conducted a meta-analysis to investigate the relationship between DM and PF or CR-PF.
  
  
  METHODS
  Embase, MEDLINE and Cochrane databases were searched systematically for relevant articles from January 2005 to June 2013. The selected studies that examined clinical risk factors of PF or CR-PF were included. We created pooled estimates for our outcomes using the random-effects model.
  
  
  RESULTS
  Sixteen observational clinical studies were included. Pooling of PF rates from ten studies revealed that DM was associated with a decreased risk of PF (P=0.01). CR-PF rates from 8 studies showed no significant difference between DM and control group (P=0.14).
  
  
  CONCLUSIONS
  DM is not a risk factor for PF in patients undergoing PD or PPPD. On the contrary, patients without DM are at a higher risk of PF because the pancreases in these patients have more fatty tissue and the pancreas is soft.
authors: Department of General Surgery, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai 200080, China. qiuzjdoctor@sina.com.
authors: Xiang
authors: X
authors: Xia
authors: Chen
authors: C
authors: Huang
authors: Gang
authors: G
authors: Cen
authors: Zheng-Jun
authors: ZJ
authors: Qiu
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D057234:Preoperative Period; D065840:Protective Factors