The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy in patients with FRS ≥ 4: a retrospective cohort study

Jiang, Yiqun; Chen, Qin; Shao, Yi; Gao, Zhenzhen; Jin, Ming; Gao, Bo; Zhou, Bo; Yan, Sheng

doi:10.1186/s12893-021-01074-w

Cited by 8 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17,18 The optimal stenting technique has also been studied comparing internal and external stents. The majority of published data indicate a more favorable outcome with external stents, 7,8,19 and this is especially true for patients with high risk, as described by Jiang and colleagues 20 who recently reported a better outcome with external stents in patients with a Fistula Risk Score of 4 or more. However, many studies have shown no difference.…”

Section: Introductionmentioning

confidence: 83%

USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience

et al. 2022

View full text Add to dashboard Cite

Background. Plastic stents have been used to avoid postoperative pancreatic fistula (POPF) following Whipple’s Pancreaticoduodenectomy (WPD), but they may cause some stent-related complications. Biodegradable stents have been recently introduced and might be a safe alternative. Here we present our initial experience with their use. Methods. Between March 1, 2020, and September 30, 2020, ten (10) consecutive patients underwent WPD. They all had conventional two-layer pancreaticojejunostomy with the placement of an internal biodegradable stent. They were assessed for technical feasibility, pancreatic leak, and stent-related complications. Results. The use of biodegradable stents was technically feasible in all patients, despite some difficulties in insertion due to stent stiffness and design. After a median follow-up period of 124 days, none of the patients suffered POPF. One patient had a biochemical pancreatic leak with no clinical significance. The median hospital stay was 7 days, and there were no stent-related complications. Conclusion. Biodegradable stents are technically feasible and safe in WPD with good short-term outcomes. They might provide a better alternative to plastic stents and their potential complications. Larger long-term studies are needed to validate efficacy and safety. Few modifications of the stent’s design might be needed to facilitate use in open surgery.

show abstract

Section: Introductionmentioning

confidence: 83%

USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience

et al. 2022

View full text Add to dashboard Cite

show abstract

“…14,28,29 Among numerous technical tricks and tips proposed to reduce POPF, the most extensively studied are anastomotic techniques, 25,30,31 use of sealant sponge, 2 reinforced stapler, 19 pancreatic stent, 32 omental flap 33,34 modalities of drainage, 35,36 or total pancreatectomy. 37 Regarding PD, externalized pancreatic drain seems the only technique able to reduce the rate of grade B to C POPF [38][39][40] but has not gained wide acceptance, maybe because of the risk of stent malfunction. 41 Also pancreaticogastrostomy could limit the risk of POPF comparatively to pancreaticojejunostomy, but with the downside of an increased risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Somatostatin Versus Octreotide for Prevention of Postoperative Pancreatic Fistula: The PREFIPS Randomized Clinical Trial

Gaujoux,

Regimbeau,

Piessen

et al. 2024

Annals of Surgery

View full text Add to dashboard Cite

Objective: Pharmacological prevention of postoperative pancreatic fistula (POPF) after pancreatectomy is open to debate. The present study compares clinically significant POPF rates in patients randomized between somatostatin versus octreotide as prophylactic treatment. Patients and methods: Multicentric randomized controlled open study in patient’s candidate for pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) comparing somatostatin continuous intravenous infusion for 7 days versus octreotid 100 μg, every 8 hours subcutaneous injection for 7 days, stratified by procedure (PD vs. DP) and size of the main pancreatic duct (>4 mm) on grade B/C POPF rates at 90 days based on an intention-to-treat analysis. Results: Of 763 eligible patients, 651 were randomized: 327 in the octreotide arm and 324 in the somatostatin arm, with comparable the stratification criteria - type of surgery and main pancreatic duct dilatation. Most patients had PD (n=480; 73.8%), on soft/normal pancreas (n=367; 63.2%) with a non-dilated main pancreatic duct (n=472; 72.5%), most often for pancreatic adenocarcinoma (n=311; 47.8%). Almost all patients had abdominal drainage (n=621; 96.1%) and 121 (19.5%) left the hospital with the drain in place (median length of stay=16 d). A total of 153 patients (23.5%) developed a grade B/C POPF with no difference between both groups: 24.1%: somatostatin arm and 22.9%: octreotide arm (Chi-2 test, P=0.73, ITT analysis). Absence of statistically significant difference persisted after adjustment for stratification variables and in per-protocol analysis. Conclusions: Continuous intravenous somatostatin is not statistically different from subcutaneous octreotide in the prevention of grade B/C POPF after pancreatectomy.

show abstract

“…However, initial randomized trials on the subject clearly demonstrated the ability of the technique to reduce morbidity and the incidence of clinically relevant PJA leaks, especially in patients at high risk of developing POPF [15][16][17]. Further research and high-quality evidence from systematic reviews and meta-analyses have confirmed the efficacy of transanastomotic external stents in reducing the incidence and grade of POPF in both randomized and nonrandomized settings [18][19][20][21]. The largest systematic review to date with meta-analysis of the POPF-related mortality rate includes 60,739 patients and undoubtedly confirmed that external transanastomotic stents decreased the POPF-related mortality rate [22].…”

Section: Transanastomotic External Pancreatic Duct Stentmentioning

confidence: 99%

Surgical Options to Mitigate the Consequences of Pancreatic Anastomosis Leak after Pancreaticoduodenectomy

Saroglu¹,

Julianov²

2023

Pancreatic Cancer- Updates in Pathogenesis, Diagnosis and Therapies

View full text Add to dashboard Cite

Pancreaticoduodenectomy is still the only treatment option that offers a chance to cure patients with pancreatic cancer and malignant periampullary tumors. Pancreaticojejunal anastomosis is the preferred method of reconstruction after pancreaticoduodenectomy. However, because of the high incidence of anastomotic leak and subsequent severe consequences, pancreaticojejunal anastomosis still remains the Achilles’ heel of the operation. Several technical modifications of pancreaticojejunal anastomosis exist, but none completely eliminates anastomotic leak, postoperative pancreatic fistula, or severe complications. Therefore, considerable efforts have been made to study and develop surgical options that can mitigate the severity and avoid fatal consequences of postoperative pancreatic fistula. This chapter presents and discusses some of the existing and emerging surgical strategies devoted to mitigating the catastrophic consequences of pancreatic anastomotic leaks.

show abstract

The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy in patients with FRS ≥ 4: a retrospective cohort study

Cited by 8 publications

References 21 publications

USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience

USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience

Somatostatin Versus Octreotide for Prevention of Postoperative Pancreatic Fistula: The PREFIPS Randomized Clinical Trial

Surgical Options to Mitigate the Consequences of Pancreatic Anastomosis Leak after Pancreaticoduodenectomy

Contact Info

Product

Resources

About