Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial

Jordan M. Winter, John L. Cameron, Kurtis A. Campbell, David C. Chang, Taylor S. Riall, Richard D. Schulick, Michael A. Choti, JoAnn Coleman, Mary B. Hodgin, Patricia K. Sauter, Christopher J. Sonnenday, Christopher L. Wolfgang, Michael R. Marohn, Charles J. Yeo

Research output: Contribution to journalArticle

234 Citations (Scopus)

Abstract

Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and stratified according to the texture of the pancreatic remnant (soft/normal versus hard). Four patients were excluded from the study; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed. Patients who randomized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis. In patients with a soft pancreas, 57 randomized to the S group and 56 randomized to the NS group. In patients with a hard pancreas, 58 randomized to the S group and 63 randomized to the NS group. The S and NS groups for the entire study population, as well as for the subgroup of high-risk patients with soft pancreata, were similar as regard to demographics, past medical history, preoperative symptoms, preoperative procedures, and intraoperative data. The pancreatic fistula rate for the entire study population was 9.4%. The fistula rates in the S and NS subgroups with hard pancreata were similar, at 1.7% and 4.8% (P = 0.4), respectively. The fistula rates in the S and NS subgroups with soft pancreata were also similar, at 21.1% and 10.7% (P = 0.1), respectively. A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation (e.g., anastomotic technique, anastomotic orientation, pancreatic duct size, and number of intra-abdominal drains placed). In patients with soft pancreata, 63% percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway (including two deaths), compared to 47% of the pancreatic fistulas in patients in the NS group (P = 0.3). Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas.

Original languageEnglish (US)
Pages (from-to)1280-1290
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume10
Issue number9
DOIs
StatePublished - Nov 2006
Externally publishedYes

Fingerprint

Pancreatic Fistula
Pancreaticoduodenectomy
Pancreatic Ducts
Stents
Pancreas
Fistula
Pancreaticojejunostomy
Preoperative Care
Pancreatectomy
Critical Pathways
Enteral Nutrition
Population
Plastics
Retrospective Studies
Demography
Prospective Studies
Pediatrics

Keywords

  • pancreatic cancer
  • pancreatic fistula
  • Pancreaticoduodenectomy
  • stent

ASJC Scopus subject areas

  • Surgery

Cite this

Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial. / Winter, Jordan M.; Cameron, John L.; Campbell, Kurtis A.; Chang, David C.; Riall, Taylor S.; Schulick, Richard D.; Choti, Michael A.; Coleman, JoAnn; Hodgin, Mary B.; Sauter, Patricia K.; Sonnenday, Christopher J.; Wolfgang, Christopher L.; Marohn, Michael R.; Yeo, Charles J.

In: Journal of Gastrointestinal Surgery, Vol. 10, No. 9, 11.2006, p. 1280-1290.

Research output: Contribution to journalArticle

Winter, JM, Cameron, JL, Campbell, KA, Chang, DC, Riall, TS, Schulick, RD, Choti, MA, Coleman, J, Hodgin, MB, Sauter, PK, Sonnenday, CJ, Wolfgang, CL, Marohn, MR & Yeo, CJ 2006, 'Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial', Journal of Gastrointestinal Surgery, vol. 10, no. 9, pp. 1280-1290. https://doi.org/10.1016/j.gassur.2006.07.020
Winter, Jordan M. ; Cameron, John L. ; Campbell, Kurtis A. ; Chang, David C. ; Riall, Taylor S. ; Schulick, Richard D. ; Choti, Michael A. ; Coleman, JoAnn ; Hodgin, Mary B. ; Sauter, Patricia K. ; Sonnenday, Christopher J. ; Wolfgang, Christopher L. ; Marohn, Michael R. ; Yeo, Charles J. / Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial. In: Journal of Gastrointestinal Surgery. 2006 ; Vol. 10, No. 9. pp. 1280-1290.
@article{af92f6ec7f6d48bb9eff0adc58de3c57,
title = "Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial",
abstract = "Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and stratified according to the texture of the pancreatic remnant (soft/normal versus hard). Four patients were excluded from the study; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed. Patients who randomized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis. In patients with a soft pancreas, 57 randomized to the S group and 56 randomized to the NS group. In patients with a hard pancreas, 58 randomized to the S group and 63 randomized to the NS group. The S and NS groups for the entire study population, as well as for the subgroup of high-risk patients with soft pancreata, were similar as regard to demographics, past medical history, preoperative symptoms, preoperative procedures, and intraoperative data. The pancreatic fistula rate for the entire study population was 9.4{\%}. The fistula rates in the S and NS subgroups with hard pancreata were similar, at 1.7{\%} and 4.8{\%} (P = 0.4), respectively. The fistula rates in the S and NS subgroups with soft pancreata were also similar, at 21.1{\%} and 10.7{\%} (P = 0.1), respectively. A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation (e.g., anastomotic technique, anastomotic orientation, pancreatic duct size, and number of intra-abdominal drains placed). In patients with soft pancreata, 63{\%} percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway (including two deaths), compared to 47{\%} of the pancreatic fistulas in patients in the NS group (P = 0.3). Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas.",
keywords = "pancreatic cancer, pancreatic fistula, Pancreaticoduodenectomy, stent",
author = "Winter, {Jordan M.} and Cameron, {John L.} and Campbell, {Kurtis A.} and Chang, {David C.} and Riall, {Taylor S.} and Schulick, {Richard D.} and Choti, {Michael A.} and JoAnn Coleman and Hodgin, {Mary B.} and Sauter, {Patricia K.} and Sonnenday, {Christopher J.} and Wolfgang, {Christopher L.} and Marohn, {Michael R.} and Yeo, {Charles J.}",
year = "2006",
month = "11",
doi = "10.1016/j.gassur.2006.07.020",
language = "English (US)",
volume = "10",
pages = "1280--1290",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "9",

}

TY - JOUR

T1 - Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial

AU - Winter, Jordan M.

AU - Cameron, John L.

AU - Campbell, Kurtis A.

AU - Chang, David C.

AU - Riall, Taylor S.

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Coleman, JoAnn

AU - Hodgin, Mary B.

AU - Sauter, Patricia K.

AU - Sonnenday, Christopher J.

AU - Wolfgang, Christopher L.

AU - Marohn, Michael R.

AU - Yeo, Charles J.

PY - 2006/11

Y1 - 2006/11

N2 - Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and stratified according to the texture of the pancreatic remnant (soft/normal versus hard). Four patients were excluded from the study; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed. Patients who randomized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis. In patients with a soft pancreas, 57 randomized to the S group and 56 randomized to the NS group. In patients with a hard pancreas, 58 randomized to the S group and 63 randomized to the NS group. The S and NS groups for the entire study population, as well as for the subgroup of high-risk patients with soft pancreata, were similar as regard to demographics, past medical history, preoperative symptoms, preoperative procedures, and intraoperative data. The pancreatic fistula rate for the entire study population was 9.4%. The fistula rates in the S and NS subgroups with hard pancreata were similar, at 1.7% and 4.8% (P = 0.4), respectively. The fistula rates in the S and NS subgroups with soft pancreata were also similar, at 21.1% and 10.7% (P = 0.1), respectively. A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation (e.g., anastomotic technique, anastomotic orientation, pancreatic duct size, and number of intra-abdominal drains placed). In patients with soft pancreata, 63% percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway (including two deaths), compared to 47% of the pancreatic fistulas in patients in the NS group (P = 0.3). Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas.

AB - Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and stratified according to the texture of the pancreatic remnant (soft/normal versus hard). Four patients were excluded from the study; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed. Patients who randomized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis. In patients with a soft pancreas, 57 randomized to the S group and 56 randomized to the NS group. In patients with a hard pancreas, 58 randomized to the S group and 63 randomized to the NS group. The S and NS groups for the entire study population, as well as for the subgroup of high-risk patients with soft pancreata, were similar as regard to demographics, past medical history, preoperative symptoms, preoperative procedures, and intraoperative data. The pancreatic fistula rate for the entire study population was 9.4%. The fistula rates in the S and NS subgroups with hard pancreata were similar, at 1.7% and 4.8% (P = 0.4), respectively. The fistula rates in the S and NS subgroups with soft pancreata were also similar, at 21.1% and 10.7% (P = 0.1), respectively. A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation (e.g., anastomotic technique, anastomotic orientation, pancreatic duct size, and number of intra-abdominal drains placed). In patients with soft pancreata, 63% percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway (including two deaths), compared to 47% of the pancreatic fistulas in patients in the NS group (P = 0.3). Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas.

KW - pancreatic cancer

KW - pancreatic fistula

KW - Pancreaticoduodenectomy

KW - stent

UR - http://www.scopus.com/inward/record.url?scp=33751204450&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33751204450&partnerID=8YFLogxK

U2 - 10.1016/j.gassur.2006.07.020

DO - 10.1016/j.gassur.2006.07.020

M3 - Article

VL - 10

SP - 1280

EP - 1290

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 9

ER -