Internal Versus External Drainage With a Pancreatic Duct Stent For Pancreaticojejunostomy During Pancreaticoduodenectomy for Patients at High Risk for Pancreatic Fistula: A Comparative Study
The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF. A total of 495 patients who unde...
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| Veröffentlicht in: | The Journal of surgical research 2018-12, Vol.232, p.247-256 |
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| creator | Zhang, Guo-qiang Li, Xiao-Hua Ye, Xiao-Jian Chen, Hai-Bin Fu, Nan-Tao Wu, An-Tao Li, Yong |
| description | The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF.
A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and outcomes between the internal and external drainage groups for subgroups of patients at high risk for PF.
There was no difference in the incidence of complications according to the Clavien-Dindo classification or the rate of PF after PD in both groups (P = 0.961 and P = 0.505, respectively). The incidence of mortality was 3.8% in the internal drainage group and 3.9% in the external drainage group (P = 0.980). Univariate and multivariate analyses identified male gender (odds ratio [OR] = 2.93; 95% confidence interval [CI], 1.78-4.83; P = 0.000), pancreatic duct diameter ( |
| doi_str_mv | 10.1016/j.jss.2018.06.033 |
| format | Article |
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A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and outcomes between the internal and external drainage groups for subgroups of patients at high risk for PF.
There was no difference in the incidence of complications according to the Clavien-Dindo classification or the rate of PF after PD in both groups (P = 0.961 and P = 0.505, respectively). The incidence of mortality was 3.8% in the internal drainage group and 3.9% in the external drainage group (P = 0.980). Univariate and multivariate analyses identified male gender (odds ratio [OR] = 2.93; 95% confidence interval [CI], 1.78-4.83; P = 0.000), pancreatic duct diameter (<3 mm) (OR = 2.58; 95% CI, 1.57-4.23; P = 0.000), and soft pancreatic texture (OR = 2.92; 95% CI, 1.71-4.98; P = 0.000) as independent risk factors for PF after PD. No differences in the incidence of PF for the subgroups of patients with one, two, or three risk factors were observed between the internal and external drainage groups (P = 0.334, P = 1.000, and P = 0.936, respectively). No differences in total complications, delayed gastric emptying, postpancreatectomy hemorrhage, biliary fistula, infection complications, reoperation, perioperative mortality, or postoperative hospital stay were noted. In addition, liquid loss and tube-related complications occurred in the external drainage group.
Internal drainage is the optimal method to prevent PF after PD for subgroups of patients at high risk for PF because the surgical procedure is simple and prevents liquid loss and tube-related complications associated with external drainage. However, no differences in the incidence of PF and other complications after PD were observed between the two approaches.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2018.06.033</identifier><identifier>PMID: 30463725</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Drainage - methods ; External drainage ; Female ; Humans ; Internal drainage ; Male ; Middle Aged ; Pancreatic duct stent ; Pancreatic Ducts ; Pancreatic fistula ; Pancreatic Fistula - epidemiology ; Pancreatic Fistula - prevention & control ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - methods ; Pancreaticojejunostomy - methods ; Postoperative Complications - prevention & control ; Risk Factors ; Stents</subject><ispartof>The Journal of surgical research, 2018-12, Vol.232, p.247-256</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-999062963c2567e2eed8320cc19541cdfb84e182ceb71466e5a60ded650d69673</citedby><cites>FETCH-LOGICAL-c353t-999062963c2567e2eed8320cc19541cdfb84e182ceb71466e5a60ded650d69673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jss.2018.06.033$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30463725$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Guo-qiang</creatorcontrib><creatorcontrib>Li, Xiao-Hua</creatorcontrib><creatorcontrib>Ye, Xiao-Jian</creatorcontrib><creatorcontrib>Chen, Hai-Bin</creatorcontrib><creatorcontrib>Fu, Nan-Tao</creatorcontrib><creatorcontrib>Wu, An-Tao</creatorcontrib><creatorcontrib>Li, Yong</creatorcontrib><title>Internal Versus External Drainage With a Pancreatic Duct Stent For Pancreaticojejunostomy During Pancreaticoduodenectomy for Patients at High Risk for Pancreatic Fistula: A Comparative Study</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF.
A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and outcomes between the internal and external drainage groups for subgroups of patients at high risk for PF.
There was no difference in the incidence of complications according to the Clavien-Dindo classification or the rate of PF after PD in both groups (P = 0.961 and P = 0.505, respectively). The incidence of mortality was 3.8% in the internal drainage group and 3.9% in the external drainage group (P = 0.980). Univariate and multivariate analyses identified male gender (odds ratio [OR] = 2.93; 95% confidence interval [CI], 1.78-4.83; P = 0.000), pancreatic duct diameter (<3 mm) (OR = 2.58; 95% CI, 1.57-4.23; P = 0.000), and soft pancreatic texture (OR = 2.92; 95% CI, 1.71-4.98; P = 0.000) as independent risk factors for PF after PD. No differences in the incidence of PF for the subgroups of patients with one, two, or three risk factors were observed between the internal and external drainage groups (P = 0.334, P = 1.000, and P = 0.936, respectively). No differences in total complications, delayed gastric emptying, postpancreatectomy hemorrhage, biliary fistula, infection complications, reoperation, perioperative mortality, or postoperative hospital stay were noted. In addition, liquid loss and tube-related complications occurred in the external drainage group.
Internal drainage is the optimal method to prevent PF after PD for subgroups of patients at high risk for PF because the surgical procedure is simple and prevents liquid loss and tube-related complications associated with external drainage. However, no differences in the incidence of PF and other complications after PD were observed between the two approaches.</description><subject>Adult</subject><subject>Aged</subject><subject>Drainage - methods</subject><subject>External drainage</subject><subject>Female</subject><subject>Humans</subject><subject>Internal drainage</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatic duct stent</subject><subject>Pancreatic Ducts</subject><subject>Pancreatic fistula</subject><subject>Pancreatic Fistula - epidemiology</subject><subject>Pancreatic Fistula - prevention & control</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Pancreaticojejunostomy - methods</subject><subject>Postoperative Complications - prevention & control</subject><subject>Risk Factors</subject><subject>Stents</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uctu1DAUtRAVHVo-gA3ykk2CH4mTwKqadmilSkWUx9Ly2HemDkk89aNi_oY_QeLLcDtDYcXKuj7nnqN7DkIvKSkpoeJNX_YhlIzQtiSiJJw_QTNKurpoRcOfohkhjBVVS6pD9DyEnuS5a_gzdMhJJXjD6hn6eTFF8JMa8BfwIQV89n0_n3plJ7UG_NXGG6x-_figJu1BRavxadIRX0eYIl44j_8iroc-TS5EN24zy9tp_S9qkjMwgX6AVw-b0WaVgFXE53Z9gz_a8G2PPLotbIhpUG_xCZ67caN8_r2D7J_M9hgdrNQQ4MX-PUKfF2ef5ufF5dX7i_nJZaF5zWPRdR0RrBNcs1o0wABMyxnRmnZ1RbVZLdsKaMs0LBtaCQG1EsSAETUxostpHqHXO92Nd7cJQpSjDRqGQU3gUpCMNh3LBoxkKt1RtXcheFjJjbej8ltJibzvTfYy9ybve5NEyNxb3nm1l0_LEczjxp-iMuHdjgD5yDsLXgadk9NgrM95SuPsf-R_A8NRrVA</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>Zhang, Guo-qiang</creator><creator>Li, Xiao-Hua</creator><creator>Ye, Xiao-Jian</creator><creator>Chen, Hai-Bin</creator><creator>Fu, Nan-Tao</creator><creator>Wu, An-Tao</creator><creator>Li, Yong</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201812</creationdate><title>Internal Versus External Drainage With a Pancreatic Duct Stent For Pancreaticojejunostomy During Pancreaticoduodenectomy for Patients at High Risk for Pancreatic Fistula: A Comparative Study</title><author>Zhang, Guo-qiang ; Li, Xiao-Hua ; Ye, Xiao-Jian ; Chen, Hai-Bin ; Fu, Nan-Tao ; Wu, An-Tao ; Li, Yong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-999062963c2567e2eed8320cc19541cdfb84e182ceb71466e5a60ded650d69673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Drainage - methods</topic><topic>External drainage</topic><topic>Female</topic><topic>Humans</topic><topic>Internal drainage</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreatic duct stent</topic><topic>Pancreatic Ducts</topic><topic>Pancreatic fistula</topic><topic>Pancreatic Fistula - epidemiology</topic><topic>Pancreatic Fistula - prevention & control</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Pancreaticojejunostomy - methods</topic><topic>Postoperative Complications - prevention & control</topic><topic>Risk Factors</topic><topic>Stents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Guo-qiang</creatorcontrib><creatorcontrib>Li, Xiao-Hua</creatorcontrib><creatorcontrib>Ye, Xiao-Jian</creatorcontrib><creatorcontrib>Chen, Hai-Bin</creatorcontrib><creatorcontrib>Fu, Nan-Tao</creatorcontrib><creatorcontrib>Wu, An-Tao</creatorcontrib><creatorcontrib>Li, Yong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Guo-qiang</au><au>Li, Xiao-Hua</au><au>Ye, Xiao-Jian</au><au>Chen, Hai-Bin</au><au>Fu, Nan-Tao</au><au>Wu, An-Tao</au><au>Li, Yong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Internal Versus External Drainage With a Pancreatic Duct Stent For Pancreaticojejunostomy During Pancreaticoduodenectomy for Patients at High Risk for Pancreatic Fistula: A Comparative Study</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2018-12</date><risdate>2018</risdate><volume>232</volume><spage>247</spage><epage>256</epage><pages>247-256</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF.
A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and outcomes between the internal and external drainage groups for subgroups of patients at high risk for PF.
There was no difference in the incidence of complications according to the Clavien-Dindo classification or the rate of PF after PD in both groups (P = 0.961 and P = 0.505, respectively). The incidence of mortality was 3.8% in the internal drainage group and 3.9% in the external drainage group (P = 0.980). Univariate and multivariate analyses identified male gender (odds ratio [OR] = 2.93; 95% confidence interval [CI], 1.78-4.83; P = 0.000), pancreatic duct diameter (<3 mm) (OR = 2.58; 95% CI, 1.57-4.23; P = 0.000), and soft pancreatic texture (OR = 2.92; 95% CI, 1.71-4.98; P = 0.000) as independent risk factors for PF after PD. No differences in the incidence of PF for the subgroups of patients with one, two, or three risk factors were observed between the internal and external drainage groups (P = 0.334, P = 1.000, and P = 0.936, respectively). No differences in total complications, delayed gastric emptying, postpancreatectomy hemorrhage, biliary fistula, infection complications, reoperation, perioperative mortality, or postoperative hospital stay were noted. In addition, liquid loss and tube-related complications occurred in the external drainage group.
Internal drainage is the optimal method to prevent PF after PD for subgroups of patients at high risk for PF because the surgical procedure is simple and prevents liquid loss and tube-related complications associated with external drainage. However, no differences in the incidence of PF and other complications after PD were observed between the two approaches.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30463725</pmid><doi>10.1016/j.jss.2018.06.033</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | The Journal of surgical research, 2018-12, Vol.232, p.247-256 |
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| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Aged Drainage - methods External drainage Female Humans Internal drainage Male Middle Aged Pancreatic duct stent Pancreatic Ducts Pancreatic fistula Pancreatic Fistula - epidemiology Pancreatic Fistula - prevention & control Pancreaticoduodenectomy Pancreaticoduodenectomy - methods Pancreaticojejunostomy - methods Postoperative Complications - prevention & control Risk Factors Stents |
| title | Internal Versus External Drainage With a Pancreatic Duct Stent For Pancreaticojejunostomy During Pancreaticoduodenectomy for Patients at High Risk for Pancreatic Fistula: A Comparative Study |
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