Pros and pitfalls of externalized trans-anastomotic stent as a mitigation strategy of POPF: a prospective risk-stratified observational series.

Published on Jul 1, 2021in Hpb3.647
· DOI :10.1016/J.HPB.2020.10.025
Stefano Andrianello15
Estimated H-index: 15
 (University of Verona), Giovanni Marchegiani32
Estimated H-index: 32
 (University of Verona)+ 6 AuthorsRoberto Salvia57
Estimated H-index: 57
 (University of Verona)
Sources
Abstract
Abstract Background Several advantages and pitfalls have been related to externalized trans-anastomotic stents (ETS) after pancreaticoduodenectomy. The purpose of this study was to investigate the effect of an ETS effect in a risk-stratified setting. Methods Data from patients at either intermediate- or high-risk for postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy were prospectively analyzed from January 2016 to December 2019. Outcomes included POPF rate, mean complication burden (ACB), and complications related to ETS malfunction. Results A total of 540 patients met the inclusion criteria. Following an intention-to-treat analysis, there was no difference in terms of POPF and the ACB in the intermediate (22 vs.29%, p = 0.148; 0.38 vs.0.24, p = 0.082) and high-risk categories (58 vs.37%, p = 0.103; 0.33 vs.0.33, p = 0.478) comparing PJ to PJ-ETS. Excluding patients experiencing ETS malfunction (n = 45, 22%), ETS was associated with a significantly reduced ACB in the intermediate-risk (0.38 vs.0.26, p = 0.009) and POPF rate in the high-risk category (58 vs.32%, p = 0.033). In patients with ETS malfunction an increased rate of severe morbidity (Clavien-Dindo ≥ III, 33 vs.19%, p = 0.044) was observed as compared to patients with functioning ETS. Conclusion ETS provides crucial advantages for prevention and mitigation of POPF depending on risk setting and its correct functioning. ETS malfunction is not uncommon and increases morbidity. Improving ETS design and fixing technique might lead to better outcomes.
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Apr 1, 2020·JAMA Surgery14.77
#1Stefano Andrianello (University of Verona)H-Index: 15
#2Giovanni Marchegiani (University of Verona)H-Index: 32
Last. Claudio Bassi (University of Verona)H-Index: 111
view all 12 authors...
Importance The operative scenarios with the highest postoperative pancreatic fistula (POPF) risk represent situations in which fistula prevention and mitigation strategies have the strongest potential to affect surgical outcomes after pancreaticoduodenectomy. Evidence from studies providing risk stratification is lacking. Objective To investigate whether pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG), both with externalized transanastomotic stent, is the best reconstruction method fo...
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Mar 1, 2020·Hpb3.65
#1Tommaso Giuliani (University of Verona)H-Index: 4
#2Stefano Andrianello (University of Verona)H-Index: 15
Last. Roberto Salvia (University of Verona)H-Index: 57
view all 9 authors...
Abstract Background Scores predicting postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) mainly use intraoperative predictors. The aim of this study is to investigate the role of pancreatic exocrine function expressed by fecal elastase (FE-1) as preoperative predictor of POPF. Methods Patients scheduled for PD at the Department of General and Pancreatic Surgery, University of Verona Hospital, from April 2017 to July 2018 were prospectively enrolled. FE-1 was measured in a...
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#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 19
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Objective:The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy.Background:The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circ
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#1Timothy H. MungroopH-Index: 8
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OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B...
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Jun 1, 2017·Annals of Surgery12.97
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 25
#2Giuseppe MalleoH-Index: 46
Last. Charles M. VollmerH-Index: 67
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Objective:This multicenter study sought to prospectively evaluate a drain management protocol for pancreatoduodenectomy (PD).Background:Recent evidence suggests value for both selective drain placement and early drain removal for PD. Both strategies have been associated with reduced rates of clinica
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Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
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#1Marc G. Besselink (UvA: University of Amsterdam)H-Index: 88
#2L. Bengt van Rijssen (UvA: University of Amsterdam)H-Index: 10
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Background Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. Methods The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the defi...
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Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 12 authors...
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.
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#2Giuseppe QueroH-Index: 13
Last. Giovanni Battista DogliettoH-Index: 34
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Severe post-operative complications after pancreaticoduodenectomy (PD) are largely due to pancreatic fistula onset. The occlusion of the main pancreatic duct using synthetic glue may prevent these complications. Aim of this study is to describe this technique and to report short- and long-term results as well as the post-operative endocrine and exocrine insufficiency. Two hundred and four patients who underwent PD with occlusion of the main pancreatic duct in a period of 15 years were retrospect...
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Aug 1, 2016·Hpb3.65
#1Saxon Connor (Christchurch Hospital)H-Index: 34
Introduction Post-operative pancreatic fistula has been well defined. However the underlying aetiology remains poorly understood. The aim of this review was to investigate whether the underlying aetiology for a proportion of patients suffering from post-operative pancreatic fistula was due to post-operative pancreatitis.
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Cited By3
Newest
Nov 3, 2021·Hpb3.65
#1Anthony Di Gioia (University of Verona)H-Index: 1
#2Tommaso Giuliani (University of Verona)H-Index: 4
Last. Roberto Salvia (University of Verona)H-Index: 57
view all 9 authors...
Abstract null null Background null Obesity has traditionally been considered a cause of increased surgical complexity and poor outcomes following pancreatoduodenectomy (PD). This study aimed at evaluating the role of obesity in terms of mortality and failure to rescue (FTR), with a particular focus on nonmalignant tumors. null null null Methods null All patients undergoing elective PD over 10 consecutive years were analyzed. Patients were stratified according to their BMI and categorized into tw...
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Aug 17, 2021·Surgery3.98
#1Chris Varghese (University of Auckland)H-Index: 4
#2Cameron I. Wells (University of Auckland)H-Index: 12
Last. Sanjay Pandanaboyana (Newcastle University)H-Index: 17
view all 6 authors...
Abstract null null Background null The incidence of and risk factors for chyle leak, as defined by the 2017 International Study Group on Pancreatic Surgery, remain unknown. null null null Methods null MEDLINE, EMBASE, and Scopus were systematically searched for studies of patients undergoing pancreatectomy that reported chyle leak according to the 2017 International Study Group on Pancreatic Surgery definition. The primary outcomes were the incidence of overall and clinically relevant chyle leak...
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Aug 1, 2021·Updates in Surgery2.80
#1Roberto Salvia (University of Verona)H-Index: 57
#2Gabriella Lionetto (University of Verona)H-Index: 1
Last. Giovanni Marchegiani (University of Verona)H-Index: 32
view all 5 authors...
Postoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a prom...
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