Postoperative Fluid Collections Following Left Pancreatectomy: Urgent Need for a Standardized Definition. A Systematic Review and Meta-Analysis

Background: Postoperative fluid collections (PFCs) are common after left pancreatectomy (LP), but their definition and incidence remain unclear. Methods: A systematic search was performed for studies published up to April 2025 reporting the incidence of PFCs after LP. PFCs were defined as radiologically detected collections within 90 days after surgery; symptomatic PFCs were those associated with clinical symptoms, infections, or requiring intervention. The primary outcome was the pooled incidence of overall and symptomatic PFCs. Results: Twenty-six studies (5 RCTs and 21 observational cohorts) were analyzed. Three RCTs reported overall PFCs and the pooled incidence was 47.9% (95% CI 32.2-64.1; I2 = 94.0%). All five RCTs reported symptomatic PFCs, with a pooled incidence of 9.6% (95% CI 7.6-12.0; I2 = 35.5%). Eighteen observational studies analyzed overall PFCs with a pooled incidence of 58.3% (95% CI 44.2-71.2; I2 = 97.7%), while symptomatic PFCs were reported in 19 cohorts with a pooled incidence of 15.0% (95% CI 11.7-19.1; I2 = 91.7%). Conclusion: PFCs incidence after LP approaches 50% overall and 10%-15% for symptomatic collections. Consistency was observed only in RCTs reporting symptomatic PFCs. Standardized, radiology-based definitions are urgently needed to improve comparability across studies and to guide.