External pancreatic duct stent reduces pancreatic fistula: A meta-analysis and systematic review

Patel, Krishen; Teta, Anthony; Sukharamwala, Prashant; Thoens, Jonathan; Mauricio, Szuchmacher; Peter, DeVito

doi:10.1016/j.ijsu.2014.06.008

Cited by 42 publications

(36 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

Section: Discussionmentioning

confidence: 99%

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

Section: Discussionmentioning

confidence: 99%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

View full text Add to dashboard Cite

show abstract

“…Influenced by the reports in which pancreatic duct stent for pancreaticojejunostomy in PD prevents POPF (8,9), pancreatic duct stent is routinely used in many Institutions. In six recent meta-analyses, three reports demonstrated that a pancreatic duct stent was useful for preventing POPF (21)(22)(23) (Table V). On the other hand, the other three meta-analyses demonstrated that such stenting did not reduce POPF (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…There are some reports comparing the efficacy of external and internal stents, finding them to have equivalent outcome (10,17). Recent meta-analyses on stenting versus non-stenting are contradictory (18)(19)(20)(21)(22)(23). Therefore, it is still controversial whether a pancreatic duct stent should be used for pancreaticojejunal anastomosis in PD.…”

mentioning

confidence: 99%

Safety of Non-stented Pancreaticojejunostomy in Pancreaticoduodenectomy for Patients with Soft Pancreas

Usuba

Misawa

Ito

et al. 2016

View full text Add to dashboard Cite

show abstract

“…(82) However, the use of an external stent was associated with reduced overall and clinically significant pancreatic fistula rates after pancreaticoduodenectomies. (83) An interesting approach after a CP was recently suggested by Di Benedetto and co-workers -duct-toduct anastomosis of the Wirsung for both pancreatic remnants. (20) An internal lost stent into the duodenum was also used to protect the anastomosis.…”

Section: Indications and Contraindications For A Central Pancreatectomentioning

confidence: 99%

Central pancreatectomy revisited

Dumitraşcu¹,

Popescu²

2015

JTMR

View full text Add to dashboard Cite

Central pancreatectomy (CP) is a parenchyma-sparing alternative resection to distal pancreatectomy, for benign and low malignant potential tumors located on the pancreatic isthmus and/ or body. Pancreatic metastases of other neoplasia might also benefit after a CP, in selected patients. Dagradi and Serio described the modern technique of CP, while Iacono introduced it in current clinical practice. An open CP represents the standard, but there is an emerging role for the minimally-invasive approach, which might become a standard for CP in experienced centers, particularly for the robotic approach. The rationale of a CP was to preserve the postoperative pancreatic functions because it implies the loss of a minimal amount of normal pancreatic tissue. However, the real clinical benefit of a CP is still controversial. High overall morbidity and pancreatic fistula rates were reported after a CP. However, most of the complications after a CP have been conservatively managed, with almost zero mortality. A CP has a minimal impact on the postoperative pancreatic functions; the diabetes mellitus rate after a CP is significantly lower, compared with the distal pancreatectomies. A proper selection of candidates for a CP is recommended. Thus, tumors located on the pancreatic isthmus are more likely to benefit after a CP, because the alternative surgical technique in these patients is an extended left pancreatectomy, a procedure with increased risk of postoperative pancreatic insufficiencies. Individual patient-related factors should be taken into consideration in the selection of the patients. Thus, a CP should be used in young patients, non-obese and without diabetes mellitus, with a good biological status, which might be able to overcome the potential postoperative complications. A CP can be safely incorporated into an experienced pancreatic surgeon armamentarium, albeit it represents an uncommon pancreatic resection. Abbreviations: Central pancreatectomy (CP); Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM).

show abstract

External pancreatic duct stent reduces pancreatic fistula: A meta-analysis and systematic review

Abstract: This analysis has shown that external pancreatic duct stenting is indeed efficacious in the incidence of both any grade as well as clinically significant POPF formation following PD. Length of hospital stay was also found to be significantly less by external duct stenting.

Cited by 42 publications

References 21 publications

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Safety of Non-stented Pancreaticojejunostomy in Pancreaticoduodenectomy for Patients with Soft Pancreas

Central pancreatectomy revisited

Contact Info

Product

Resources

About