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11.10.2016 | Original Article | Ausgabe 12/2016

Journal of Gastrointestinal Surgery 12/2016

Externalized Stents for Pancreatoduodenectomy Provide Value Only in High-Risk Scenarios

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 12/2016
Autoren:
Matthew T. McMillan, Brett L. Ecker, Stephen W. Behrman, Mark P. Callery, John D. Christein, Jeffrey A. Drebin, Douglas L. Fraker, Tara S. Kent, Major K. Lee, Robert E. Roses, Michael H. Sprys, Charles M. Vollmer Jr.
Wichtige Hinweise
Podium presentation at the 12th World Congress of the International Hepato-Pancreato-Biliary Association Sao Paulo, Brazil, April 23, 2016.

Abstract

Background

Evidence suggests externalized trans-anastomotic stents may be beneficial as a fistula mitigation strategy for pancreatoduodenectomy (PD); however, previous studies have not been rigorously risk-adjusted.

Methods

From 2001 to 2015, PDs were performed at three institutions, with externalized stents placed at the surgeon’s discretion. The Fistula Risk Score (FRS) and the Modified Accordion Severity Grading System were used to analyze occurrence and severity of clinically relevant postoperative pancreatic fistula (CR-POPF) across various risk scenarios.

Results

Of 729 PDs, externalized stents were placed during 129 (17.7 %). Overall, CR-POPFs occurred in 77 (10.6 %) patients. The median FRS of patients who received externalized stents was significantly higher compared with patients who did not (6 vs. 3, p < 0.0001). Patients with negligible, low, or moderate CR-POPF risk (FRS 0–6) did not demonstrate improved outcomes with externalized stents; however, among high-risk patients (FRS 7–10), stents were associated with significantly reduced rates of CR-POPF (14.0 vs. 36.4 %, p = 0.031), severe complications (p = 0.039), and hospital stay (p = 0.014) compared with no stents. The average complication burden of CR-POPF was significantly lower for patients with externalized stents (p = 0.035).

Conclusion

This multicenter study, the largest comparative analysis of externalized trans-anastomotic stents versus no stent for PD, demonstrates a risk-stratified benefit to externalized stents.

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