Does preoperative prophylactic pancreatic duct stenting prior to enucleation mitigate the risk of postoperative fistula: A meta-analysis.

Abstract

Pancreatic enucleation is a surgical technique selectively used for its preservation of pancreatic parenchyma. Despite this, evidence supports enucleation being associated with high rates of postoperative pancreatic fistula. This meta-analysis aims to evaluate the role of prophylactic preoperative main pancreatic duct stenting in reducing the rate of postoperative pancreatic fistula. A systematic review and meta-analysis was performed of the pre-existing literature regarding prophylactic pre-enucleation main pancreatic duct stenting. The primary outcome measure was the rate of clinically relevant postoperative pancreatic fistula. Data were pooled for analysis using an odds ratio with a random effects model. Risk of bias was determined as per the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four cohort studies comprising 197 patients were included, with 78 (39.6%) undergoing prophylactic main pancreatic duct stenting. All studies used either 5F or 7F stents of varying lengths (4-12 cm), inserted either on the operative day or the day before. Timing of stent removal displayed more heterogeneity (4-16 weeks). Stenting was well tolerated with no reported increased rate of acute pancreatitis and no reported severe postoperative complications directly attributable to stenting. Crucially, preoperative main pancreatic duct stenting was associated with a significantly lower rate of clinically relevant postoperative pancreatic fistula (21.8% vs 45.4%) (odds ratio [95% CI]: 0.36 [0.18-0.71], P = .0033). Preoperative main pancreatic duct stenting is associated with a reduced rate of clinically relevant postoperative pancreatic fistula after pancreatic enucleation. Furthermore, preoperative stenting is a well-tolerated intervention with no reported increased burden of complications. These findings merit further prospective randomized investigation into routine stent use in patients undergoing pancreatic enucleation.