Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy

Xiong, Junjie; Altaf, Kiran; Mukherjee, Rajarshi; Huang, Wei; Hu, Weiming; Li, A; Ke, Nengwen; Liu, X B

doi:10.1002/bjs.8788

Cited by 90 publications

(59 citation statements)

References 51 publications

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“…This modified technique leads us to decrease pancreatic leaks and fistula with the rationale that stenting prevents the accumulation of pancreatic secretions, so the pancreaticojejunostomy is excluded from direct contact with pancreatic juice [14]. Several studies examined the efficacy of internal and external pancreatic stents in preventing POPF but the results are still in contrast [23,24]. POPF is the most important complication of pancreaticoduodenectomy because, directly or indirectly, contributes to the other morbidity including DGE, postpancreatectomy hemorrhage and death.…”

Section: Discussionmentioning

confidence: 99%

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Agrusa

Gallucci

Buono

et al. 2015

International Journal of Surgery

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a b s t r a c tIntroduction: Pancreatic cancer is the fourth cause of death from cancer in Western countries. The radical surgical resection is the only curative option for this pathology. The prevalence of this disease increases with age in population. The causes of pancreatic cancer are unknown, but we consider risk factors like smoke and tobacco usage, alcohol consumption coffee, history of diabetes or chronic pancreatitis. In this study we report our experience in the treatment of resectable pancreatic cancer and periampullary neoplasms with particular attention to evaluate the evolution of surgical technique and the clinical postoperative outcomes. Methods: In our Department between January 2010 and December 2014 we performed a total of 97 pancreaticoduodenectomy. We considered only resectable pancreatic cancer and periampullary neoplasms defined by absence of distant metastases, absence of local tumor extension to the celiac axis and hepatic artery as the lack of involvement of the superior mesenteric vasculature. None of these patients received neoadjuvant chemotherapy. Results: The mean age of these patients was 64.5 years. Jaundice was the commonest presenting symptom associated to anorexia and weight loss. The mean operative time was 295 min (±55 min). The mean blood loss was 450 ml and median blood transfusion was 1 units. 12.1% of patients had an intraabdominal complication. The commonest complication was Delayed Gastric Emptying responsable of increased length of hospital stay and readmission rate. Postoperative pancreatic fistula of grade C occurred in 4 patients. 2 patients developed a postpancreatectomy hemorrhage. Perioperative mortality was 4.1%. Conclusion: Pancreaticoduodenectomy is a complex surgical technique and the associated high morbidity and mortality resulted in initial reluctance to adopt this surgery for the management of pancreatic and periampullary tumors. Surgical outcomes of pancreatic surgery are better at high-volume experienced center reporting mortality rates below 5%. We perform an end-to-side duct-to-mucosa pancreaticojejunostomy with routinely use of internal pancreatic stent. However no one technique has been shown to definitely be the solution to the problem of postoperative pancreatic fistula. At our center we have a reasonable volume and our data are comparable to literature data.

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Section: Discussionmentioning

confidence: 99%

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Agrusa

Gallucci

Buono

et al. 2015

International Journal of Surgery

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“…Some prospective randomized [71][72][73], non-randomized studies and a meta-analysis showed external stents reduced the rates of pancreatic fistula when compared to no stents or internal stents [74][75][76][77]. In a recent meta-analysis by Hong et al (external stents versus no stents) showed no difference in clinical outcome, but reduced the rates of POPF and related morbidity and hospital stay [77].…”

Section: Role Of Stentsmentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

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“…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

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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.

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Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy

Cited by 90 publications

References 51 publications

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Pancreatoduodenectomy - Preventing Complications

Pancreatic Duct Stents at Pancreaticoduodenectomy: A Meta-Analysis

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