IZUMO Wataru
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position  
Article types Original article
Language English
Peer review Non peer reviewed
Title Propensity score-matched analysis of internal stent vs external stent for pancreatojejunostomy during pancreaticoduodenectomy: Japanese-Korean cooperative project.
Journal Formal name：Pancreatology
Abbreviation：Pancreatology
ISSN code：14243911/14243903
Domestic / ForeginForegin
Volume, Issue, Page 20(5),pp.984-991
Author and coauthor Kawai Manabu, Yamaue Hiroki, Jang Jin-Young, Uesaka Katsuhiko, Unno Michiaki, Nakamura Masafumi, Fujii Tsutomu, Satoi Sohei, Choi Seong Ho, Sho Masayuki, Fukumoto Takumi, Kim Song Cheol, Hong Tae Ho, Izumo Wataru, Yoon Dong Sup, Amano Ryosuke, Park Sang-Jae, Choi Sae Byeol, Yu Hee Chul, Kim Joo Seop, Ahn Young Joon, Kim Hongbeom, Ashida Ryo, Hirono Seiko, Heo Jin Seok, Song Ki Byung, Park Joon Seong, Yamamoto Masakazu, Shimokawa Toshio, Kim Sun-Whe
Publication date 2020/07
Summary BACKGROUND:Several studies comparing internal and external stents have been conducted with the aim of reducing pancreatic fistula after PD. There is still no consensus, however, on the appropriate use of pancreatic stents for prevention of pancreatic fistula. This multicenter large cohort study aims to evaluate whether internal or external pancreatic stents are more effective in reduction of clinically relevant pancreatic fistula after pancreaticoduodenectomy (PD).METHODS:We reviewed 3149 patients (internal stent n = 1,311, external stent n = 1838) who underwent PD at 20 institutions in Japan and Korea between 2007 and 2013. Propensity score matched analysis was used to minimize bias from nonrandomized treatment assignment. The primary endpoint was the incidence of clinically relevant pancreatic fistula. This study was registered on the UMIN Clinical Trials Registry (UMIN000032402).RESULTS:After propensity score matched analysis, clinically relevant pancreatic fistula occurred in more patients in the external stents group (280 patients, 28.7%) than in patients in the internal stents group (126 patients, 12.9%) (OR 2.713 [95% CI, 2.139-3.455]; P < 0.001). In subset analysis of a high-risk group with soft pancreas and no dilatation of the pancreatic duct, clinically relevant pancreatic fistula occurred in 90 patients (18.8%) in internal stents group and 183 patients (35.4%) in external stents group. External stents were significantly associated with increased risk for clinically relevant pancreatic fistula (OR 2.366 [95% CI, 1.753-3.209]; P < 0.001).CONCLUSION:Propensity score matched analysis showed that, regarding clinically relevant pancreatic fistula after PD, internal stents are safer than external stents for pancreaticojejunostomy.
DOI 10.1016/j.pan.2020.06.014
PMID 32680728