The Effect of Prophylactic Transpapillary Pancreatic Stent Insertion On the Clinically Significant Leak Rate Following Distal Pancreatectomy: Results of a Prospective Controlled Clinical Trial

Farshad Frozanpor, PhD, L Lundell, PhD, R Segersvärd, PhD, U Arnelo, PhD. Department of Clinical Science and Education and Department of Clinical Science, Intervention and Technology

 

Background: PF causes major morbidity after DP. Transpapillary pancreatic stenting has been suggested to be beneficial in treating established PF and also prophylactically, to reduce the risk of PF after DP.The objective was to determine if prophylactic pancreatic duct stenting reduces pancreatic fistula(PF) formation after distal pancreatectomy (DP). Methods: Patients scheduled for DP during October 2006 to December 2010 were assessed and, if eligible, randomized to DP without or with stenting before transection of the neck of the gland (DP + stent). The DP procedure was standardized and the follow-up period included the first 30 postoperative days. The outcomes were assessed according to the intention-to-treat analysis principle. Results: 64 patients were assessed and 58 randomized to either DP (n = 29) or DP+stent (n = 29). Mean operating time for DP was 218.8 ± 94.1(SD) vs. 283.3 ± 131.9 for DP + stent (P = 0.052). A clinically significant PF (ISGPF classification Grade B or C) occurred in 6 DPs (22.2%) and 11 (42.3%) DP stent patients (OR, 2.57; 95% CI, 0.78–8.48; P = 0.122). The mean hospital stay for patients without a stent was 13.4 ± 6.4 days, compared to 19.4 ± 14.4 days for those provided with a pancreatic stent (P= 0.071). Conclusion: The results from this trial show that prophylactic pancreatic stenting does not reduce PF when performing a standardized resection of the body and tail of the pancreas.


Session Number: SS03 – HPB (Hepatobiliary and Pancreas)
Program Number: S012

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