American journal of surgery · 2024
Stent placement for the prevention of clinically-relevant postoperative pancreatic fistula following pancreaticojejunostomy: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Sun Ying, Li Yongfeng, Liu Zhiqiang, Peng Tao, Wang Chunyou, Wu Heshui, Gou Shanmiao
Аннотация
OBJECTIVES: There remains a lack of consensus regarding the benefits of stent placement following pancreaticojejunostomy in terms of clinically relevant postoperative pancreatic fistulas (CR-POPFs). This study was aimed at analyzing the effects of stent placement, stent technique (internal and external), stent size, and dilation of the main pancreatic duct on CR-POPFs.
METHODS: Our study comprised a systematic review and meta-analysis of randomized controlled trials involving patients undergoing pancreaticojejunostomy. The primary outcome was defined as the incidence of CR-POPFs. Additionally, subgroup analyses were conducted, and pooled analyses were performed to provide comparative references.
RESULTS: Twelve randomized controlled trials, including a total of 1117 patients, were included. Compared with no stent placement, stenting did not exhibit a significant association with reduced CR-POPF incidence (odds ratio [OR] = 0.60, 95% CI: 0.34-1.04, P = 0.07). Subgroup analysis revealed that only external stents, and not internal stents, were significantly associated with a reduced CR-POPF incidence compared with no stent placement (OR = 0.53, 95% CI: 0.28-0.99, P = 0.05 vs. OR = 0.92, 95% CI: 0.28-3.05, P = 0.89). Furthermore, stent placement in patients with a main pancreatic duct diameter of ≤3 mm, and not in those with a main pancreatic duct diameter of >3 mm, was associated with a significantly reduced CR-POPF incidence compared with no stent placement (OR = 0.24, 95% CI: 0.07-0.78, P = 0.02 vs. OR = 1.58, 95% CI: 0.41-6.06, P = 0.50).
CONCLUSIONS: The findings suggest a potential role for external stent placement in the prevention of CR-POPFs after pancreaticojejunostomy, particularly in patients with undilated pancreatic ducts. The reliability of our findings is constrained by the limited number of studies included.
PROSPERO REGISTRATION NUMBER: CRD42022380103.
METHODS: Our study comprised a systematic review and meta-analysis of randomized controlled trials involving patients undergoing pancreaticojejunostomy. The primary outcome was defined as the incidence of CR-POPFs. Additionally, subgroup analyses were conducted, and pooled analyses were performed to provide comparative references.
RESULTS: Twelve randomized controlled trials, including a total of 1117 patients, were included. Compared with no stent placement, stenting did not exhibit a significant association with reduced CR-POPF incidence (odds ratio [OR] = 0.60, 95% CI: 0.34-1.04, P = 0.07). Subgroup analysis revealed that only external stents, and not internal stents, were significantly associated with a reduced CR-POPF incidence compared with no stent placement (OR = 0.53, 95% CI: 0.28-0.99, P = 0.05 vs. OR = 0.92, 95% CI: 0.28-3.05, P = 0.89). Furthermore, stent placement in patients with a main pancreatic duct diameter of ≤3 mm, and not in those with a main pancreatic duct diameter of >3 mm, was associated with a significantly reduced CR-POPF incidence compared with no stent placement (OR = 0.24, 95% CI: 0.07-0.78, P = 0.02 vs. OR = 1.58, 95% CI: 0.41-6.06, P = 0.50).
CONCLUSIONS: The findings suggest a potential role for external stent placement in the prevention of CR-POPFs after pancreaticojejunostomy, particularly in patients with undilated pancreatic ducts. The reliability of our findings is constrained by the limited number of studies included.
PROSPERO REGISTRATION NUMBER: CRD42022380103.