Pancreatic Duct Stents at Pancreaticoduodenectomy: A Meta-Analysis

Abstract

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.

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

“…The majority of reviews comparing patients with and without stents did not report any differences in the POPF rate, [39,41,43,44,47] overall mortality, [39–41,43,44,47] or the morbidity rate. [39–41,43,47] Only Zhou et al [40] in 2012 reported a significantly greater POPF rate in patients with a normal pancreas who underwent internal stenting.…”

“…[39–41,43,47] Only Zhou et al [40] in 2012 reported a significantly greater POPF rate in patients with a normal pancreas who underwent internal stenting. In 2013, the same authors [44] also reported a significant increase in overall morbidity in stented patients.…”

“…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.…”

“…While 4 reviews compared external versus internal stents, [39,41,46,47] none reported differences in the overall morbidity or mortality rates, and 3 reported no differences in the POPF rate. [39,41,47] Only Ke et al [46] reported a lesser POPF rate in patients with a normal pancreas who were managed with external pancreatic stents after a PD.…”

Pancreatic Fistula Extending into the Thigh Caused by the Rupture of an Intraductal Papillary Mucinous Adenoma of the Pancreas

“…In our patient, a pancreatic fistula was suspected, and a pancreatic stent was placed on Day 14 in order to prevent the leakage of pancreatic juice into the fistula. Studies showing that the use of a pancreatic stent was effective for the management of pancreatic fistulas associated with surgery or trauma have been sporadically reported (11-14). In our patient, the amylase level in the exudates from the open wound decreased from 21,802 IU/L to 435 IU/L after the placement of the pancreatic stent, suggesting that the pancreatic stent suppressed the leakage of pancreatic juice into the fistula (Fig.…”