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01-12-2016 | Original Article

Externalized Stents for Pancreatoduodenectomy Provide Value Only in High-Risk Scenarios

Authors: Matthew T. McMillan, Brett L. Ecker, Stephen W. Behrman, Mark P. Callery, John D. Christein, Jeffrey A. Drebin, Douglas L. Fraker, Tara S. Kent, Major K. Lee, Robert E. Roses, Michael H. Sprys, Charles M. Vollmer Jr.

Published in: Journal of Gastrointestinal Surgery | Issue 12/2016

Abstract

Background

Evidence suggests externalized trans-anastomotic stents may be beneficial as a fistula mitigation strategy for pancreatoduodenectomy (PD); however, previous studies have not been rigorously risk-adjusted.

Methods

From 2001 to 2015, PDs were performed at three institutions, with externalized stents placed at the surgeon’s discretion. The Fistula Risk Score (FRS) and the Modified Accordion Severity Grading System were used to analyze occurrence and severity of clinically relevant postoperative pancreatic fistula (CR-POPF) across various risk scenarios.

Results

Of 729 PDs, externalized stents were placed during 129 (17.7 %). Overall, CR-POPFs occurred in 77 (10.6 %) patients. The median FRS of patients who received externalized stents was significantly higher compared with patients who did not (6 vs. 3, p < 0.0001). Patients with negligible, low, or moderate CR-POPF risk (FRS 0–6) did not demonstrate improved outcomes with externalized stents; however, among high-risk patients (FRS 7–10), stents were associated with significantly reduced rates of CR-POPF (14.0 vs. 36.4 %, p = 0.031), severe complications (p = 0.039), and hospital stay (p = 0.014) compared with no stents. The average complication burden of CR-POPF was significantly lower for patients with externalized stents (p = 0.035).

Conclusion

This multicenter study, the largest comparative analysis of externalized trans-anastomotic stents versus no stent for PD, demonstrates a risk-stratified benefit to externalized stents.

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Title: Externalized Stents for Pancreatoduodenectomy Provide Value Only in High-Risk Scenarios
Authors: Matthew T. McMillan
Brett L. Ecker
Stephen W. Behrman
Mark P. Callery
John D. Christein
Jeffrey A. Drebin
Douglas L. Fraker
Tara S. Kent
Major K. Lee
Robert E. Roses
Michael H. Sprys
Charles M. Vollmer Jr.
Publication date: 01-12-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3289-6

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Springer Medicine

Externalized Stents for Pancreatoduodenectomy Provide Value Only in High-Risk Scenarios

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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