Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

Zhou, Yanming; Yang, Chao; Wang, Shuangjia; Chen, Jingxi; Li, Bin

doi:10.1159/000330222

Cited by 39 publications

(28 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[38–42,47] Unlike our results, the reviews did not report any differences in the overall mortality rate. [38–42,45,47] …”

Section: Discussioncontrasting

confidence: 67%

“…Seven reviews reported a significant decrease in the POPF rate in externally stented patients, [38–42,45,47] 4 reviews reported a significant decrease in the rates of Grades B and C POPFs, [38,41,42,45] and 6 reviews also reported a significant decrease in the overall morbidity rate. [38–42,47] Unlike our results, the reviews did not report any differences in the overall mortality rate.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

View full text Add to dashboard Cite

Background:Pancreatoduodenectomy (PD) is one of the most technically demanding operations challenging surgeons, and a postoperative pancreatic fistula (POPF) can complicate an otherwise uneventful postoperative (PO) course. This review examined the methods and procedures used to prevent postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD).Methods:A comprehensive systematic search of the literature was performed using PubMed (Medline), Embase, Web of science, and the Cochrane databases for studies published between January 1, 1990 and December 31, 2015. English language articles involving at least 100 patients undergoing PDs carried out in centers performing at least 10 PDs/y were screened for data regarding the Grade of any POPFs according to the definition of the International Study Group on Pancreatic Fistula (ISGPF) and the overall rate of PO mortality related to POPF.Results:We reviewed 7119 references through the major databases, and an additional 841 studies were identified by cross-checking the bibliographies of the full-text articles retrieved. After excluding 7379 out of 7960 studies, because they did not meet the eligibility criteria, the full texts of 581 articles were examined; 96 studies were excluded at this point, because they concerned partially or totally duplicate data that had already been reported. The remaining 485 articles were screened carefully for POPF-related mortality and POPF Grades as defined by the ISGPF. Of the 485 articles, 208 reported the POPF-related PO mortality rate and 162 the Grades (A, B, and C) of POPFs in 60,739 and 54,232 patients, respectively. The POPF-related mortality rates after pancreatojejunostomy and pancreatogastrostomy were similar but were less (0.5% vs. 1%; P = .014) when an externally draining, trans-anastomotic stent was placed intraoperatively. The incidence of the different Grades of POPF Grade was quite variable, but Grade C POPFs were associated with a PO mortality rate of 25.7% (range 0–100%).Conclusions:The POPF-related mortality rate has remained at approximately 1% over the past 25 years. Only externally draining, trans-anastomotic stents decreased the POPF-related mortality rate. However, adequately designed venting drains were never tested in randomized controlled trials (RCTs).

show abstract

“…[38–42,47] Unlike our results, the reviews did not report any differences in the overall mortality rate. [38–42,45,47] …”

Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

View full text Add to dashboard Cite

show abstract

“…28 In addition, external drainage of pancreatic juice by inserting a tube into the main pancreatic duct is a technique that has been suggested to prevent a pancreatic fistula, in which pancreatic juice is diverted away from anastomosis. 29 Miwa et al 13 reported no pancreatic leak in a series of 22 patients undergoing complete external drainage of pancreatic juice, followed by second-stage pancreatojejunostomy. Thus accepting the relatively low levels of evidence on which to base decisions the authors propose the current algorithm (Fig.…”

Section: Discussionmentioning

confidence: 98%

A systematic review of safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers

Zhou¹,

Zhang²,

et al. 2016

HPB

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, confirming the published literature, we found that the conclusions were often under debate. So far, five meta-analyses [18,19,20,21,22] on this topic have been already performed to evaluate perioperative outcomes, but those conclusions might be not reliable enough for clinical decision-making as they are based on both RCTs and observational studies. There were not even any relatively indispensable interpretations of subgroup analysis or sensitivity analysis.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic Duct Stents at Pancreaticoduodenectomy: A Meta-Analysis

Wang

Tian

et al. 2013

Dig Surg

View full text Add to dashboard Cite

Background and Objective: Several studies suggested that pancreatic stents had some benefit during pancreatoduodenectomy (PD), but others disagree. Whether pancreatic duct stents could prevent postoperative pancreatic fistula (POPF) is still under controversy. Methods: Randomized controlled trials published before November 2012 were all aggregated, focusing on the evaluation of pancreatic duct stents during PD. Trial data was reviewed and extracted independently by two reviewers. The quality of the including studies was assessed by the Cochrane handbook 5.1.0. Results: Seven studies were included, with a total of 793 patients. The results showed that compared with nonstents, stents during PD was associated with a significant difference on overall POPF rate (OR = 0.65, 95% CI 0.45-0.95, p = 0.02), POPF grades B and C (OR = 0.45, 95% CI 0.27-0.76, p = 0.003), and hospital stay (MD = -4.28, 95% CI -6.81, -1.75, p = 0.0009). Subgroup analyses showed that the external stent had a significant difference in the incidence of overall POPF (OR = 0.46, 95% CI 0.29-0.73, p = 0.0009), POPF grades B and C (OR = 0.49, 95% CI 0.30-0.79, p = 0.003), postoperative morbidity (OR = 0.63, 95% CI 0.42-0.96, p = 0.03), as well as hospital stay. Conclusions: Based upon this meta-analysis, there might be potential benefit in reducing POPF thanks to the use of pancreatic duct stents.

show abstract

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

Cited by 39 publications

References 34 publications

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

A systematic review of safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers

Pancreatic Duct Stents at Pancreaticoduodenectomy: A Meta-Analysis

Contact Info

Product

Resources

About