Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy

Toshiyuki Moriya, Clancy J. Clark, Yujiro Kirihara, Michael L. Kendrick, Kaye M Reid Lombardo, Florencia Que, Michael B. Farnell

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: To evaluate the efficacy of transanastomotic pancreatic duct internal stenting in the reduction of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Design: Retrospective study. Setting: Mayo Clinic. Patients: Between January 1, 1999, and September 30, 2010, 553 patients underwent pancreaticoduodenectomy by a single surgeon. Main Outcome Measures: Rates of POPF, morbidity, and mortality between stent and no-stent groups. Results: The clinically relevant POPF (International Study Group on Pancreatic Fistula definition grade B or C) rates in the stent and no-stent groups were similar (9.6% [43 of 449 patients] and 12.5% [13 of 104 patients], respectively; P=.38). Postoperative outcomes and morbidity were also similar between the 2 groups. Mortality was 0.7% (3 of 449 patients) for the stent group and 1.0% (1 of 104 patients) for the no-stent group. Four patients (0.9%) required endoscopic retrieval of the anastomotic stent. In subset analysis, the clinically relevant POPF rates in patients with a small pancreatic duct (≤3 mm; n=167) were similar in the stent and no-stent groups (17.7% [23 of 130 patients] and 24.3% [9 of 37 patients], respectively; P=.38). In patients with a soft pancreatic gland (n=64), rates of clinically relevant pancreatic fistulae were also similar in the stent and no-stent groups (31.7% [13 of 41 patients] and 17.4% [4 of 23 patients], respectively; P=.20). Conclusions: Internal transanastomotic pancreatic duct stenting does not decrease the frequency or severity of POPF. The effect of stenting on long-term anastomotic patency warrants further investigation.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalArchives of Surgery
Volume147
Issue number1
DOIs
StatePublished - Jan 2012

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Pancreatic Fistula
Pancreaticoduodenectomy
Stents
Pancreatic Ducts
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Moriya, T., Clark, C. J., Kirihara, Y., Kendrick, M. L., Lombardo, K. M. R., Que, F., & Farnell, M. B. (2012). Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy. Archives of Surgery, 147(1), 35-40. https://doi.org/10.1001/archsurg.2011.850

Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy. / Moriya, Toshiyuki; Clark, Clancy J.; Kirihara, Yujiro; Kendrick, Michael L.; Lombardo, Kaye M Reid; Que, Florencia; Farnell, Michael B.

In: Archives of Surgery, Vol. 147, No. 1, 01.2012, p. 35-40.

Research output: Contribution to journalArticle

Moriya, T, Clark, CJ, Kirihara, Y, Kendrick, ML, Lombardo, KMR, Que, F & Farnell, MB 2012, 'Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy', Archives of Surgery, vol. 147, no. 1, pp. 35-40. https://doi.org/10.1001/archsurg.2011.850
Moriya, Toshiyuki ; Clark, Clancy J. ; Kirihara, Yujiro ; Kendrick, Michael L. ; Lombardo, Kaye M Reid ; Que, Florencia ; Farnell, Michael B. / Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy. In: Archives of Surgery. 2012 ; Vol. 147, No. 1. pp. 35-40.
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abstract = "Objective: To evaluate the efficacy of transanastomotic pancreatic duct internal stenting in the reduction of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Design: Retrospective study. Setting: Mayo Clinic. Patients: Between January 1, 1999, and September 30, 2010, 553 patients underwent pancreaticoduodenectomy by a single surgeon. Main Outcome Measures: Rates of POPF, morbidity, and mortality between stent and no-stent groups. Results: The clinically relevant POPF (International Study Group on Pancreatic Fistula definition grade B or C) rates in the stent and no-stent groups were similar (9.6{\%} [43 of 449 patients] and 12.5{\%} [13 of 104 patients], respectively; P=.38). Postoperative outcomes and morbidity were also similar between the 2 groups. Mortality was 0.7{\%} (3 of 449 patients) for the stent group and 1.0{\%} (1 of 104 patients) for the no-stent group. Four patients (0.9{\%}) required endoscopic retrieval of the anastomotic stent. In subset analysis, the clinically relevant POPF rates in patients with a small pancreatic duct (≤3 mm; n=167) were similar in the stent and no-stent groups (17.7{\%} [23 of 130 patients] and 24.3{\%} [9 of 37 patients], respectively; P=.38). In patients with a soft pancreatic gland (n=64), rates of clinically relevant pancreatic fistulae were also similar in the stent and no-stent groups (31.7{\%} [13 of 41 patients] and 17.4{\%} [4 of 23 patients], respectively; P=.20). Conclusions: Internal transanastomotic pancreatic duct stenting does not decrease the frequency or severity of POPF. The effect of stenting on long-term anastomotic patency warrants further investigation.",
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AB - Objective: To evaluate the efficacy of transanastomotic pancreatic duct internal stenting in the reduction of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Design: Retrospective study. Setting: Mayo Clinic. Patients: Between January 1, 1999, and September 30, 2010, 553 patients underwent pancreaticoduodenectomy by a single surgeon. Main Outcome Measures: Rates of POPF, morbidity, and mortality between stent and no-stent groups. Results: The clinically relevant POPF (International Study Group on Pancreatic Fistula definition grade B or C) rates in the stent and no-stent groups were similar (9.6% [43 of 449 patients] and 12.5% [13 of 104 patients], respectively; P=.38). Postoperative outcomes and morbidity were also similar between the 2 groups. Mortality was 0.7% (3 of 449 patients) for the stent group and 1.0% (1 of 104 patients) for the no-stent group. Four patients (0.9%) required endoscopic retrieval of the anastomotic stent. In subset analysis, the clinically relevant POPF rates in patients with a small pancreatic duct (≤3 mm; n=167) were similar in the stent and no-stent groups (17.7% [23 of 130 patients] and 24.3% [9 of 37 patients], respectively; P=.38). In patients with a soft pancreatic gland (n=64), rates of clinically relevant pancreatic fistulae were also similar in the stent and no-stent groups (31.7% [13 of 41 patients] and 17.4% [4 of 23 patients], respectively; P=.20). Conclusions: Internal transanastomotic pancreatic duct stenting does not decrease the frequency or severity of POPF. The effect of stenting on long-term anastomotic patency warrants further investigation.

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