External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial.
OBJECTIVE
Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy. External drainage of pancreatic duct with a stent has been shown to reduce pancreatic fistula rate of pancreaticojejunostomy in a few retrospective or prospective nonrandomized studies, but no randomized controlled trial has been reported thus far. This single-center prospective randomized trial compared the results of pancreaticoduodenectomy with external drainage stent versus no stent for pancreaticojejunal anastomosis.


METHODS
A total of 120 patients undergoing pancreaticoduodenectomy with end-to-side pancreaticojejunal anastomosis were randomized to have either an external stent inserted across the anastomosis to drain the pancreatic duct (n = 60) or no stent (n = 60). Duct-to-mucosa anastomosis was performed in all cases.


RESULTS
The 2 groups were comparable in demographic data, underlying pathologies, pancreatic consistency, and duct diameter. Stented group had a significantly lower pancreatic fistula rate compared with nonstented group (6.7% vs. 20%, P = 0.032). Radiologic or surgical intervention for pancreatic fistula was required in 1 patient in the stented group and 4 patients in the nonstented group. There were no significant differences in overall morbidity (31.7% vs. 38.3%, P = 0.444) and hospital mortality (1.7% vs. 5%, P = 0.309). Two patients in the nonstented group and none in the stented group died of pancreatic fistula. Hospital stay was significantly shorter in the stented group (mean 17 vs. 23 days, P = 0.039). On multivariate analysis, no stenting and pancreatic duct diameter <3 mm were significant risk factors of pancreatic fistula.


CONCLUSIONS
External drainage of pancreatic duct with a stent reduced leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy.
Poon
Ronnie T P
RT
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. poontp@hkucc.hku.hk
Fan
Sheung Tat
ST
Lo
Chung Mau
CM
Ng
Kelvin K
KK
Yuen
Wai Key
WK
Yeung
Chun
C
Wong
John
J
D016009:Chi-Square Distribution; D004322:Drainage; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
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