Back to 2025 Posters
TO STENT OR NOT TO STENT? INTERNAL VS EXTERNAL VS NO PANCREATIC DUCT STENT TO DECREASE POSTOPERATIVE PANCREATIC FISTULAS: A SYSTEMATIC REVIEW AND BAYESIAN NETWORK META-ANALYSIS
Gustavo Salgado-Garza
*1, Kathryn L. Fowler
1, Cynthia Araradian
1, David E. Hinojosa-Gonzalez
2, Flavio G. Rocha
1, Brett C. Sheppard
1, Patrick J. Worth
11Department of Surgery, Oregon Health & Science University, Portland, OR; 2Baylor College of Medicine Michael E DeBakey Department of Surgery, Houston, TX
Background:
Postoperative pancreatic fistulas (POPF) occur in about 20% of patients who undergo surgical removal of the head of the pancreas. POPFs are associated with increased mortality in the postoperative period and delayed receipt of adjuvant chemotherapy. Variations in surgical technique have been the main focus of research evaluating ways to decrease the rates of POPF. One major area of research interest is utilizing a stent in the pancreatic duct during pancreaticojejunostomy. Published randomized controlled trials have found conflicting results when using internal or external pancreatic duct stents. The lack of a clear trend in the literature highlights the need to answer this debate. Therefore, we performed a network meta-analysis to compare internal, external, and no pancreatic duct stent after surgery.
Methods:
We conducted a PRISMA-compliant systematic review comparing internal, external, and no pancreatic duct stent with clinically relevant POPF as a main outcome. Secondary outcomes include any grade POPF (including biochemical leak), length of hospital stay, and major complications. Major complications were defined as any Clavien-Dindo ?3 complication. Studies published up until November 2024 were included. The International Study Group for Pancreatic Surgery definition of POPF was followed. A Bayesian network meta-analysis with fixed effects was performed using R. Outcomes are reported in odds ratios (OR) and Bayesian credible intervals (CrI). This project is registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols under ID 7142.
Results:
Twelve randomized control trials with a total of 1,548 patients were included and analyzed. Three groups were compared head-to-head: no stent (N = 443), internal stent (N = 512), and external stent (N = 593). The overall clinically relevant POPF rate was 16% and any grade fistula or leak rate was 30%. For clinically relevant POPF, there was no benefit for external or internal stenting compared to no stent (external stents OR = 0.71, 95% CrI = 0.37-1.29; internal stent OR = 0.68, 95% CrI 0.33-1.41). For any grade fistula/leak, external stent showed an OR = 0.69, 95% CrI 0.40-1.12; while internal stent showed an OR = 0.73, 95% CrI = 0.41-1.27. Additionally, there was no difference in hospital length of stay or rate of major complications. Forest plots for all analyses are shown in Figure 1.
Conclusion:
Pancreatic duct stents, whether external or internal, provide no benefit in terms of clinically relevant pancreatic fistulas. No improvement in any grade of fistula, length of hospital stay, or major complications was seen.
Figure 1. Forest plots comparing external and internal pancreatic duct stent to no stent. A) Clinically relevant POPF, B) Any grade POPF, C) Length of hospital stay, D) Major complications.
Figure 2. Table of included studies and their main characteristics.
Back to 2025 Posters
