Kato Tomotaka, Watanabe Yuichiro, Baba Yasutaka, Oshima Yuhei, Takase Kenichiro, Watanabe Yukihiro, Okada Katsuya, Aikawa Masayasu, Okamoto Kojun, Koyama Isamu
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Surgery. 2025 Feb;178:108845. doi: 10.1016/j.surg.2024.09.007. Epub 2024 Oct 8.
Several risk-stratified studies have compared the outcomes of external and internal pancreatic stents in pancreatoduodenectomy (PD), but no resolute standard for a fistula-mitigation strategy exists. The study investigated the efficacy of these stents in a preoperative risk-stratified setting.
Data from 285 patients who underwent PD with pancreaticojejunostomy using an external or internal stent from 2015 to 2023 were analyzed. The preoperative pancreatic fistula score (preFRS) was used to classify patients into low-risk (preFRS: 0-5) and high-risk (preFRS: 6-8) groups.
PreFRS accurately predicted the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) as 0% and >40% in patients with preFRS ≤1 and ≥7, respectively. Although no significant difference was observed in postoperative outcomes in low-risk patients, the external stent significantly reduced CR-POPF (21% vs 44%, P = .024) and postpancreatectomy hemorrhage (PPH, 0% vs 19%, P = .02) in high-risk patients, leading to the superiority of the external stent in the entire cohort in terms of CR-POPF (12% vs 24%, P = .033) and PPH (1% vs 11%, P = .013). There were no significant differences in stent-related complications or pancreatic dysfunction. External stent malfunction occurred in 14% and significantly affected CR-POPF development in both low- (20% vs 0%, P < .01) and high-risk groups (60% vs 14%, P = .021).
The external pancreatic stent showed a more beneficial effect on CR-POPF and PPH, especially in high-risk patients, without increasing other complications. Risk-stratified strategy and improving stent management might enhance postoperative outcomes.
多项风险分层研究比较了胰十二指肠切除术（PD）中外置和内置胰腺支架的效果，但尚未存在明确的预防胰瘘策略标准。本研究在术前风险分层的情况下探究了这些支架的疗效。
分析了2015年至2023年期间285例行胰十二指肠切除术并行胰空肠吻合术时使用外置或内置支架的患者数据。术前胰腺瘘评分（preFRS）用于将患者分为低风险（preFRS：0 - 5）和高风险（preFRS：6 - 8）组。
preFRS分别准确预测了preFRS≤1和≥7的患者临床相关术后胰瘘（CR - POPF）风险为0%和>40%。虽然低风险患者术后结果无显著差异，但外置支架显著降低了高风险患者的CR - POPF（21%对44%，P = 0.024）和胰十二指肠切除术后出血（PPH，0%对19%，P = 0.02），使整个队列中外置支架在CR - POPF（12%对24%，P = 0.033）和PPH（1%对11%，P = 0.013）方面具有优势。支架相关并发症或胰腺功能障碍无显著差异。14%的外置支架发生故障，且在低风险组（20%对0%，P < 0.01）和高风险组（60%对14%，P = 0.021）中均显著影响CR - POPF的发生。
外置胰腺支架对CR - POPF和PPH显示出更有益的效果，尤其是在高风险患者中，且未增加其他并发症。风险分层策略和改善支架管理可能会提高术后结果。
