Short internal pancreatic stent reduces pancreatic fistula in pancreatoduodenectomy
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ORIGINAL ARTICLE
Short internal pancreatic stent reduces pancreatic fistula in pancreatoduodenectomy Teijiro Hirashita 1 & Yukio Iwashita 1 & Atsuro Fujinaga 1 & Hiroaki Nakanuma 1 & Kazuhiro Tada 1 & Takashi Masuda 1 & Yuichi Endo 1 & Masayuki Ohta 1 & Masafumi Inomata 1 Received: 1 August 2020 / Accepted: 15 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major complication of pancreatoduodenectomy (PD). A pancreatic stent is usually used for drainage of the pancreatic duct, but the best type of the stent remains unclear. The aim of this study was to investigate perioperative factors and their influence on the risk of CR-POPF following PD. Methods From 2006 to 2019, the records of 246 patients who underwent PD were retrospectively reviewed, and the relationship between perioperative factors including type of pancreatic stent and CR-POPF was investigated. External or internal pancreatic stents were used for drainage of the pancreatic duct, and the internal stent was inserted 1 cm into the jejunum to decrease stent obstruction. Results External and internal pancreatic stents were used in 137 and 109 patients, respectively. Multivariate analysis revealed that the diameter of the main pancreatic duct (odds ratio = 0.292, 95% confidence interval = 0.140–0.605, P = 0.001), diagnosis (odds ratio = 3.359, 95% confidence interval = 1.498–7.693, P = 0.003), and type of pancreatic stent (odds ratio = 0.435, 95% confidence interval = 0.203–0.934, P = 0.033) were independent factors related to CR-POPF after PD. Internal stent was associated with a low rate of CR-POPF (P < 0.001) and short postoperative hospital stay (P < 0.001) compared to external stent. Conclusion A short pancreatic internal stent could decrease the incidence of CR-POPF. Keywords Pancreatoduodenectomy . Pancreatectomy . Pancreatic fistula . Pancreatic stent
Introduction Pancreatoduodenectomy (PD) is an established surgical procedure for the treatment of malignant and benign diseases of the pancreatic and periampullary regions. Postoperative pancreatic fistula (POPF) is a major complication of PD, and the rate of clinically relevant POPF (CR-POPF) remains high, ranging from 8.2 to 37% [1–6]. CR-POPF leads to prolonged hospitalization, increased treatment costs, and death as the worst possible outcome. The mortality rate after PD has decreased to less than 5% in high-volume centers with experienced surgeons due to a decrease in CR-POPF and
* Teijiro Hirashita [email protected] 1
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita 879-5593, Japan
improvements in postoperative management [1, 7–9], but it remains difficult to maintain a mortality rate of zero. Many risk factors for CR-POPF following PD have been reported, including a high body mass index (BMI), prolonged operation time, large amount of blood loss, soft pancreas, small pancreatic duct, and small number of
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