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The Prognostic Value of External vs Internal Pancreatic Duct Stents in CR-POPF after Pancreaticoduodenectomy: A Systematic Review and Meta-analysis.

Published on Feb 25, 2020in Journal of Investigative Surgery1.642
· DOI :10.1080/08941939.2019.1691687
Yuancong Jiang (ZJU: Zhejiang University), Qin Chen (LMB: Laboratory of Molecular Biology)+ 6 AuthorsSheng Yan14
Estimated H-index: 14
(ZJU: Zhejiang University)
Abstract
Background: There is no specific evidence regarding the benefits of external and internal pancreatic duct stents after pancreaticoduodenectomy since pancreatic fistula (grade A) have been redefined with no clinical treatment effect. We aimed to reevaluate the prognostic value of external and internal stents in clinically relevant postoperative pancreatic fistula over pancreaticoduodenectomy.Methods: PubMed, Web of Science, EMBASE and the Cochrane Database were specifically searched for pertinent and original articles published before May 2019. The project has been registered in PROSPERO (Registration number: CRD42019137579).Results: Four randomized controlled trials and six nonrandomized controlled trials with a total of 2101 patients were enrolled in this meta-analysis. The use of an external stent resulted in better performance than the use of an internal stent in terms of pancreatic fistula (grade C) (OR 0.58, P = 0.03) but did not reduce the rate of pancreatic fistula (grade B) (OR 0.99, P = 0.94) in all studies. The meta-analysis of randomized controlled trials found that the use of an external stent approached a level of significance for an increased rate of clinically relevant postoperative pancreatic fistula compared to the use of an internal stent (OR 1.40, P = 0.10) but had no significant effect on pancreatic fistula (grade B) (OR 1.34, P = 0.26) or pancreatic fistula (grade C) (OR 1.68, P = 0.62).Conclusion: Compared with internal stents, the use of external stent might be associated with a lower rate of pancreatic fistula (grade C). More randomized clinical trials are warranted to further explore safety and efficacy of pancreatic duct external stents.
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References48
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#1Dimitrios Xourafas (The Ohio State University Wexner Medical Center)H-Index: 5
#2Aslam Ejaz (The Ohio State University Wexner Medical Center)H-Index: 3
Last. Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 9
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Background Recent studies on postoperative pancreatic fistula (POPF) prevention suggest that omission of perioperative drains is safe for negligible- or low-risk patients undergoing pancreatoduodenectomy (PD). However, this proposed pathway has not been validated in a nationwide cohort. Study Design The ACS-NSQIP–targeted pancreatectomy database from 2014 to 2016 was queried to identify patients who underwent PD. Using a previously validated modified Fistula Risk Score (mFRS), patients were stra...
3 CitationsSource
#1Y.C. Shin (Inje University)H-Index: 9
#2Jin-Young Jang (Seoul National University Hospital)H-Index: 34
Last. Hak Jae Kim (Seoul National University Hospital)H-Index: 108
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Abstract Background To determine the most appropriate pancreatic drainage method, by investigating differences in 12-month clinical outcomes in patients implanted with external and internal pancreatic stents as an extension to a previous study on short-term outcome. Methods This prospective randomized controlled trial enrolled 213 patients who underwent pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy between August 2010 and January 2014 (NCT01023594). Of the 185 patients follo...
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#1Guoqiang Zhang (NCU: Nanchang University)H-Index: 2
#2Xiao-Hua Li (NCU: Nanchang University)H-Index: 1
Last. Yong Li (NCU: Nanchang University)H-Index: 1
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Abstract Background The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF. Materials and methods A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and o...
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#1Yu Shi (PRC: China Medical University (PRC))H-Index: 6
#2Ying Liu (PRC: China Medical University (PRC))H-Index: 2
Last. Qiyong Guo (PRC: China Medical University (PRC))H-Index: 2
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Quantitative preoperative MR assessments of mechanical and morphologic characteristics of the pancreatic stump are strongly predictive of pancreaticoenteric anastomotic fistula. Lower pancreatic stiffness was associated with relatively less pancreatic fibrosis, higher grade of acinar atrophy, and lipomatosis.
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#2Karzan Seerwan Abdulla (University of Sulaymaniyah)H-Index: 1
Last. Fattah Hama Rahim (University of Sulaymaniyah)H-Index: 1
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Abstract Background Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgery that carries a high rate of major complications, including delayed gastric emptying (DGE), pancreatic fistula, bleeding, intra-abdominal collection, and pulmonary complications. In this study, we have tried to demonstrate the outcomes, and rates of complications from patients who had undergone this procedure by our surgical team. Materials and Methods This retrospective study has been constructed on...
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#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 12
#2Matthew T. McMillanH-Index: 17
Last. Charles M. VollmerH-Index: 40
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Objective:The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy.Background:The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circ
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#1F. Jasmijn Smits (UU: Utrecht University)H-Index: 4
Last. Quintus Molenaar (UU: Utrecht University)H-Index: 22
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Importance Postoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking. Objective To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula after pancreatoduodenectomy. Design, Setting, and Participants A multicenter, retrospective, propensity-matched cohort study was conducted in 9 centers of the Dutch Pancreatic Cancer G...
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#1Shailesh V. Shrikhande (ACTREC: Tata Memorial Hospital)H-Index: 30
#2Masillamany Sivasanker (ACTREC: Tata Memorial Hospital)H-Index: 2
Last. Markus W. Büchler (Heidelberg University)H-Index: 127
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Background Clinically relevant postoperative pancreatic fistula (grades B and C of the ISGPS definition) remains the most troublesome complication after pancreatoduodenectomy. The approach to management of the pancreatic remnant via some form of pancreatico-enteric anastomosis determines the incidence and severity of clinically relevant postoperative pancreatic fistula. Despite numerous trials comparing diverse pancreatico-enteric anastomosis techniques and other adjunctive strategies (pancreati...
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#1Claudio BassiH-Index: 80
Last. Markus W. Büchler (Heidelberg University)H-Index: 127
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Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
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