Abstract
Abstract Background: Two methods of pancreatic duct decompression following pancreaticoduodenectomy (PD) are currently employed, the internal and external pancreatic duct stent. Previous analysis of the efficacy of ductal decompression following PD has been confounded by either including both the internal and external stent method or by small sample size. The aim of this meta-analysis was to analyze the efficacy of the external pancreatic duct stent method alone in preventing Post-Operative Pancreatic Fistula (POPF) formation and other complications in patients undergoing PD. Methods: A systematic literature search was conducted using the Medline, Cochrane Library, SCI, and EMBASE databases on all studies published from January 1970 to March 2012 reporting the peri-operative outcomes following PD. The primary end-point was the incidence of POPF formation in the presence of external pancreatic duct stent placement. Secondary outcomes considered included the incidence of post-operative mortality, Delayed Gastric Emptying (DGE), postoperative wound infection, operative time and blood loss, and length of hospital stay. Results: Four trials were included comprising 416 patients. There was a statistically significant decrease in the incidence of both any grade POPF formation (OR 0.37, 95% CI=0.23 to 0.58, P=0.0001) and clinically significant (grade B or C) POPF formation (OR 0.50, 95% CI=0.30 to 0.84, P=0.0009) in patients receiving an external pancreatic duct stent versus no stent following PD. Total length of hospital stay was also found to be shortened with the use of an external stent (SMD -0.39, 95% CI=-0.63 to -0.15, P=0.001). Conclusions: There is a decreased incidence of POPF formation following PD in patients receiving an external pancreatic duct stent versus patients receiving no stent. Total length of hospital stay was also found to be favorably affected by placement of an external pancreatic duct stent.
Highlights
The National Cancer Institute has estimated that there will be as many as 45,220 new cases of pancreatic cancer in the U.S in 2012 and that as many as 38,460 patients will die of the disease this year alone [1]
Post-Operative Pancreatic Fistula (POPF) is believed to be a consequence of pancreatic exocrine secretion seepage across a compromised anastomotic site, with the most likely mechanism being autodigestion and destruction of the tissue surrounding the PJ anastomotic site leading to dehiscence and seepage into the abdominal cavity
The present study excluded two trials previously included by Markar et al [10]; 1) the 2009 prospective trial conducted by Smyrniotis et al [5] on the basis that this study examined internal stents only, and 2) the 2006 trial conducted by Winter et al [4] on the basis that internal stents were included and because these authors utilized an alternating method of allocating patients to either treatment or control arms, which may Number of patients Age Male/Female BMI Pancreatic duct size Pancreatic texture Jadad’s score12
Summary
POPF is believed to be a consequence of pancreatic exocrine secretion seepage across a compromised anastomotic site, with the most likely mechanism being autodigestion and destruction of the tissue surrounding the PJ anastomotic site leading to dehiscence and seepage into the abdominal cavity The release of these activated pancreatic juices cause peripancreatic collections, intra-abdominal abscesses, hemorrhage, and POPF [2]. Previous analysis of the efficacy of ductal decompression following PD has been confounded by either including both the internal and external stent method or by small sample size The aim of this meta-analysis was to analyze the efficacy of the external pancreatic duct stent method alone in preventing Post-Operative Pancreatic Fistula (POPF) formation and other complications in patients undergoing PD
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