Abstract
Postoperative pancreatic fistula (POPF) remains a common and serious complication following pancreatic resection. Intra pancreatic fat deposition (IPFD) has been increasingly recognized as a potential modifiable risk factor, but its clinical significance across different surgical procedures is not fully defined. This study aims to comprehensively evaluate the correlation between IPFD and POPF by integrating bibliometric trends with meta-analytic evidence. This study employed a dual-method approach. First, a bibliometric analysis was conducted on 3698 publications from the Web of Science Core Collection (2005-2025) to map the research landscape, trends, and collaborative networks in POPF research. Subsequently, a systematic review and meta-analysis were performed following PRISMA guidelines, with literature retrieved from four databases: PubMed, Web of Science, Embase, and Scopus. The meta-analysis ultimately included 22 studies for quantitative synthesis. Random or fixed effects models were used to pool odds ratios (ORs) for the association between IPFD and POPF following pancreatoduodenectomy (PD) and distal pancreatectomy (DP), respectively. Bibliometric analysis revealed a consistent dynamic growth in research on POPF, with the focus evolving from early definitional studies toward precision prediction and prevention. China, the United States, and Japan emerged as the leading contributors in this field. The meta-analysis, which incorporated 22 studies involving 687 patients with POPF (grades B/C), demonstrated a significant positive association between IPFD and POPF following PD (OR: 2.33, 95% CI 1.64-3.31, p < 0.001). In contrast, analysis of DP studies showed no significant correlation (OR: 0.79, 95% CI 0.26-2.42, p = 0.69). The overall incidence of POPF (B/C) across included studies was 26% (95% CI 20-32%). Considerable heterogeneity was observed, partially attributable to regional variations and inconsistent IPFD measurement methodologies. IPFD appears to be a significant preoperative predictor for POPF after PD but not after DP. This procedure-specific association underscores the importance of integrating preoperative IPFD assessment into clinical risk stratification for PD patients to guide tailored surgical planning and perioperative management. Future efforts should focus on standardizing IPFD quantification to enhance its utility in predictive models and personalized preventive strategies.