Misdiagnosis of Suspected Cancer in Pancreatoduodenectomy: A Systematic Review and Prevalence Mata-Analysis.

[BACKGROUND] Differentiating between pancreatic cancer (PC) and benign pancreatic lesions is challenging, leading to misdiagnosis and unnecessary pancreatoduodenectomy (PD). This systematic review and meta-analysis aimed to determine the prevalence of PC misdiagnosis in PD.

[METHODS] A systematic review was conducted following PRISMA guidelines and was prospectively registered on PROSPERO (CRD42024510669). We included 21 studies comprising 13,660 patients who underwent PD for suspected malignancy. A random-effects meta-analysis with 95% confidence interval (CI) was used to calculate the pooled prevalence of misdiagnosis and risk ratios of surgical complications or clinical manifestations.

[RESULTS] The pooled prevalence of misdiagnosed cancer cases was 8.35% (95% CI: 7.26-9.59). Chronic pancreatitis was the most common benign condition mistaken for cancer, with a pooled prevalence of 40.69% (95% CI 28.47-58.15). The most frequently reported preoperative symptoms included abdominal pain (62.54%), jaundice (52.05%), and weight loss (52.71%). Misdiagnosis was associated with abdominal pain as a clinical presentation, whereas jaundice was more common in malignancy (OR 2.21, 95% CI 1.15-4.24). Malignant pathology was associated with higher risks of postoperative pancreatic fistula (RR 2.01, 95% CI 1.18-3.43) and mortality (RR 2.57, 95% CI 1.06-6.24). Misdiagnoses were more prevalent among younger male patients, with females comprising 39.86% (95% CI 31.18-46.48) of the cohort.

[DISCUSSION] Pancreatic cancer misdiagnosis leading to surgical intervention remains a prevalent condition, with young male patients without weight loss being the most affected population and chronic pancreatitis the major differential diagnosis.