Intervention Review

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Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy

  1. Zhiyong Dong1,2,
  2. Jing Xu1,*,
  3. Zhen Wang3,
  4. Maxim S Petrov4

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 26 JUN 2013

Assessed as up-to-date: 4 APR 2011

DOI: 10.1002/14651858.CD008914.pub2


How to Cite

Dong Z, Xu J, Wang Z, Petrov MS. Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008914. DOI: 10.1002/14651858.CD008914.pub2.

Author Information

  1. 1

    The First Affiliated Hospital of Guangxi Medical University, Hepato-Pancreato-Biliary Surgery, Nanning, Guangxi, China

  2. 2

    Affiliated Hospital of Pu Tian University, Hepato-Pancreato-Biliary Surgery, Putian, Fujian Province, China

  3. 3

    The First Affiliated Hospital of Guangxi Medical University, Department of Gastrointestinal Surgery, Nanning, Guangxi, China

  4. 4

    The University of Auckland, Department of Surgery, Auckland, New Zealand

*Jing Xu, Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6, Shuang Yong Road, Nanning, Guangxi, 530021, China. jxuapr@yahoo.com.cn.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JUN 2013

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Several studies have demonstrated that the use of pancreatic duct stents following pancreaticoduodenectomy is associated with a lower risk of pancreatic fistula. However, to date, there is a lack of accord in the literature on whether the use of stents is beneficial and, if so, whether internal or external stenting is preferable.

Objectives

To determine the efficacy of pancreatic stents in preventing pancreatic fistula after pancreaticoduodenectomy.

Search methods

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ISI Web of Science and four major Chinese biomedical databases were searched up to February 2011. We also searched four major trials registers.

Selection criteria

Randomized controlled trials (RCTs) comparing the use of stents (either internal or external) versus no stents, and comparing internal stents versus external stents following pancreaticoduodenectomy.

Data collection and analysis

Two authors extracted the data independently. The outcomes studied were incidence of pancreatic fistula, need for reoperation, length of hospital stay, overall complications, and in-hospital mortality. The results were shown as relative risk (RR) with 95% confidence interval (CI).

Main results

A total of 656 patients were included in the systematic review. Overall, the use of stents (both external and internal) was not associated with a statistically significant change in any of the studied outcomes. In a subgroup analysis, it was found that the use of external, but not internal, stents is associated with a significant reduction in the incidence of pancreatic fistulae (RR 0.33; 95% CI 0.11 to 0.98, P = 0.04), the incidence of complications (RR 0.48; 95% CI 0.25 to 0.92, P = 0.03) and length of hospital stay (RR -0.57; 95% CI -0.94 to -0.21, P = 0.002). In RCTs on the use of internal versus external stents, no statistically significant difference was found in terms of any of the studied outcomes.

Authors' conclusions

This systematic review suggests that the use of external stents following pancreaticoduodenectomy may be beneficial. However, only a limited number of RCTs with rather small sample sizes were available. Further RCTs on the use of stents after pancreaticoduodenectomy are warranted.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy

The use of stents following pancreaticoduodenectomy was studied in 656 patients from five randomised controlled trials. Overall, the use of stents did not improve clinically meaningful outcomes. However, a subgroup analysis demonstrated a significant reduction in the incidence of pancreatic fistula, major complications and length of hospital stay with the use of external stents when compared with no stents. Further adequately-powered randomized controlled trials are warranted to confirm the effectiveness of external stents.